RESULTS: Of 3206 seniors randomly selected from two managed health plans, 2,278 (71%) were interviewed and 475 were identified as``vulnerable''. For the 400 (84%) patients who consented to study participation and had abstractable medical records, 67% of 324 CC QIs were satisfied. Of 185 seniors started on new medications during the study, 67% had follow-up of this medication at the next physician visit. Of 72 patients who were hospitalized, 89% received postdischarge follow-up within 6 weeks; 6 of 11 had follow-up of a medication started in the hospital and 10 of 14 had follow-up of a test pending at hospital discharge, but only 41% had a copy of the discharge summary in the outpatient chart. CONCLUSION: Vulnerable elders at two managed care plans received a high level of CC of care. Measuring CC care identifies aspects that require intervention. In an effort to control health care costs, many third party payers limited physicians' abilities to order expensive tests for their patients, requiring the use of an appeals process to obtain restricted medical services. Studies suggest that, at times, physicians are willing to misrepresent clinical information to third party payers in order to obtain these services for their patients. Little is known about whether characteristics of the appeals process influence physicians' willingness to sanction deception. METHODS: We surveyed a random sample of 1,617 physicians in the U.S., and presented each with a hypothetical scenario in which an insurance company refused to pay for a medically important service. We varied the``hassle'' of the appeals process by varying the time required to make an appeal and the likelihood of having a successful appeal. In addition, we varied the severity of the patient's health condition from moderate low back pain to severe angina.