Department  of Health  and Human  Services 
OFFICE OF

INSPECTOR GENERAL

MEDICARE  BENEF  CIARY  SATISFACTION:

1995

#>-
$- 0 * 
$  JUNE  GIBBS  BROWN 
:  Inspector  General 
s
% 
%%. ,
DECEMBER  1996
%>d ~~
OEI-04-93-00150  OFFICE  OF  INSPECTOR  GENERAL 
The  mission of the Office  of Inspector  General  (OIG),  as mandated  by Public Law 
95-452, is to protect  the integrity of the Department  of Health and Human  Services 
programs  as well as the health and welfare  of beneficiaries  served by them.  This 
statutory mission is carried out through a nationwide  program  of audits, investigations, 
inspections,  sanctions, and fraud alerts.  The  Inspector  General  informs the Secretary 
of program  and management  problems  and recommends  legislative, regulatory, and 
operational  approaches  to correct  them. 
Office  of Evaluation  and  Inspections 
The  Office  of Evaluation  and Inspections  (OEI)  is one  of several components  of the

Office  of  Inspector  General.  It conducts  short-term management  and program

evaluations  (called  inspections)  that focus on issues of concern  to the Department,  the

Congress,  and the public.  The  inspection  reports provide  findings and

recommendations  on the efficiency, vulnerability, and effectiveness  of departmental

programs.

OEIS Atlanta Regional  Office  prepared  this report  under the direction  of Jesse J.

Flowers,  Regional  Inspector  General,  and Christopher  Koehler,  Deputy  Regional

Inspector  General.  Principal OEI  staff included:

Retion  Headmasters

Betty Apt,  Team  Leader  Stuart Wright, I+ogram  Specialist

James Green,  Contractor  Brian Ritchie,  Technical  Support

Jackie Watkins, Program  Analyst  Barbara Tedesco,  Stat&ician

Joe Townsel,  Program  Analyst

Tammy  Hipple,  Statistician

To  obtain  a copy  of this report,  call the Atlanta Regional  Office  at 404-331-4108.
 Department  of Health  and Human  Services 
OFFICE OF

INSPECTOR GENERAL

EDICARE  BENEFICIARY  SATISFACTION: 
1995 
~+~  -0,9 
JUNE  GIBBS  BROWN 
# 
$  Inspector  General 
s 
5 
%++ @ 
DECEMBER  1996 
> 
4*daa OEI-04-93-00150  EXECUTIVE  SUMMARY

PURPOSE 
To  determine  beneficiary  experience  and satisfaction with Medicare  services. 
BACKGROUND 
This is the fifth survey the Office  of Inspector  General  (OIG),  Department  of Health 
and Human  Services (HHS),  has conducted  to determine  beneficiary  experience  and 
satisfaction with Medicare  services.  In September  1995, we surveyed  1244 randomly 
selected  beneficiaries  for whom  Medicare  Part B claims were  submitted in Calendar 
Year  1994.  Participation  in the survey was voluntary and yielded  a response  rate of 76 
percent--942  beneficiaries. 
FINDINGS 
Beneficiaries  report  positive experience  with the Medicare  program. 
	 Beneficiary  Understanding--Eighty  percent  of the beneficiaries  responding  to 
our survey said the Medicare  program was understandable. 
Getting  Information--Seventy-eight  percent  of the beneficiaries  said they could 
	
get information  about  Medicare  when they needed  it.  Most  beneficiaries  said 
they would  consult their physician (70 percent)  or their Medicare  Handbook 
(56 percent)  to get specific  information. 
Claims Processing--Eighty-seven  percent  of the beneficiaries  said they were 
	
satisfied with the way Medicare  carriers processed  their claims. 
Beneficiary  understanding of and satisfaction with certain Medicare  seMces  has 
improved. 
  Claims Processing--In  1994, 30 percent  of beneficiaries  said they experienced  at 
least one  problem  with their last Medicare  claim.  In 1995, the percent  of 
beneficiaries  who  experienced  a problem  dropped  to  19 percent. 
Speed  of Claims Processing--In  1994, 73 percent  of beneficiaries  said Medicare 
	
paid their claims quickly enough.  In 1995, 80 percent  said their claims were 
paid quickly enough. 
	 Home  Health  Charges--In  1994, 32 percent  of the beneficiaries  who  had 
received  home  heal;h  services did not understand what home  health services 
Medicare  paid for.  That percent  decreased  to  11 percent  in 1995. 
i  Certain Medicare  program  semkes  which needed  improvement  in 1994 continued  to 
need  improvement  in 1995. 
	 Telephone  Semke--Fifty-eight  percent  of beneficiaries  who had called their 
carriers experienced  at least one problem  when calling.  Twenty-eight  percent 
who  had tried to call had to call three or more  times to get through. 
	 Second  Surgical Opinions--Sixty  percent  of the beneficiaries  surveyed did not 
know Medicare  pays for a second  opinion  on the need  for surgery. 
Physician Fees--Twenty-six  percent  of the beneficiaries  surveyed did not know 
9	
Medicare  limits physicians fees for specific  sefices. 
s	 Appeal  Rights--Thirty-four  percent  of beneficiaries  surveyed did not know they 
could  appeal  or request a review of decisions Medicare  carriers made  about 
their claims.  Further, 31 percent  of beneficiaries  who  had appealed  did not 
understand the final appeal  decision. 
	 Hospital  Charges--Nineteen  percent  of the beneficiaries  who  had been 
hospitalized  did not understand what hospital charges Medicare  had paid for. 
Other  program  seMces  also need  improvement. 
	 Flu Immunizations--One-fourth  (24 percent)  of the beneficiaries  surveyed did 
not know Medicare  paid for flu immunizations. 
Mammograms--One-fourth  (24 percent)  of the female  beneficiaries  surveyed 
	
did not know Medicare  paid for mammograms. 
*	 Hospice  Care--Forty-two  percent  of beneficiaries  did not know Medicare  paid 
for hospice  care. 
	 Peer Review  Organizations  (PRO}-Over  three-fourths  (78 percent)  of the 
beneficiaries  did not know each State has a Medicare-funded  PRO  to monitor 
the cost and quality of health care provided  to Medicare  beneficiaries. 
RECOMMENDATION 
We  recommend  that the Health Care Financing Administration  develop  a plan for 
improving beneficia~  satisfaction and understanding in the problem  areas mentioned 
above. 
ii  AGENCY  COMMENTS 
The  HCFA  Administrator  commented  on our report,  and concurred  with our 
recommendation.  He  reported  that HCFA  has implemented  new Contractor 
Performance  Evaluation  procedures  that allow regional offices  to expand  their reviews 
to include customer  service areas that need  special attention, such as telephone 
setice.  Further, the new procedures  ensure that beneficiary  input is incorporated  into 
reviews.  The  HCFA  is also revising letters to beneficiaries  to improve  the clarity of 
information  about  appeals. 
... 
111
 TABLE  OF  CONTENTS

PAGE 
EXECUTIVE  SUMMARY 
INTRODUCHON  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

FINDINGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Beneficiaries  Report  Positive Experience  with the Medicare  Program  . . . . . . . .  3

Generally  Understand  the Program  . . . . . . . . . . . . . . . . . . . . . . . . . . ...3

Can Get Needed  Information  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4

Knew About  and Used  Participating Physicians  . . . . . . . . . . . . . . . . . . . .  5

Are  Satisfied WithClaims Processing  . . . . . . . . . . . . . . . . . . . . . . . . . . ..6

Are  Satisfied with Carrier Telephone  Service  . . . . . . . . . . . . . . . . . . . . . .  7

Beneficiary  Understanding  of and Satisfaction with Certain 
Medicare  Services has Improved  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...8

Fewer  Identified  Claims Processing Problems  . . . . . . . . . . . . . . . . . . . . .  8

More  Satisfied with Speed  of Claim Payments  . . . . . . . . . . . . . . . . . . . .  10

More  Understand  Home  Health Payments  . . . . . . . . . . . . . . . . . . . . . .  10

Certain Services Continue to Need Improvement  . . . . . . . . . . . . . . . . . . . . . .  10

Calling Carriers  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...10

Second  Surgical Opinions  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13

Limits on Physician Fees.....  . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13

Appeal  Rights  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...14

Appeal  Decisions  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...14

Understanding  Hospital  Payments  . . . . . . . . . . . . . . . . . . . . . . . . . . ...15

Other  Program  ServicesAlso  Need  Improvement  . . . . . . . . . . . . . . . . . . . . .  15

Flu Immunizations  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...15

Mammograms  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...15

Hospice  Care  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...15

Peer Review  Organizations  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...15

RECOMMENDATION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...16

AGENCY  COMMEN1ll  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...17

ENDNOTES  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..  .. . . . . . . . . . . ...18

APPENDICES 
Responses  to  1995 Survey of Medicare  Beneficia~  Satisfaction  . . . . . . . . . . .  A-1

Analysis of Respondents  vs. Non-Respondents  . . . . . . . . . . . . . . . . . . . . . . .  B-1

HCFA  Comments  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..C-1
 INTRODUCTION

PURPOSE 
To  determine  beneficiary  experience  and satisfaction with Medicare  services. 
BACKGROUND 
Medicare  is a Federal  health insurance program  for individuals age 65 and older,  and 
for certain categories  of disabled  people.  Medicare  was authorized  in 1965 by title 
XVIII  of the Social Security Act.  In Fiscal Year  1995, Medicare  served approximately 
37.6 million people,  known as beneficiaries,  and paid benefits  totalling over  $159 
billion.1 
The  Health  Care Financing Administration  (HCFA),  Department  of Health and 
Human  Services (HHS),  has responsibility for the Medicare  program.  However,  other 
organizations  share program  administration.  The  Social Security Administration 
establishes eligibility, enrolls beneficiaries  in the program,  and collects  Medicare 
premiums.  Private health insurance companies  contract with the Federal  Government 
to service claims for Medicare  payment.  Insurance companies  that handle hospital 
claims are called intermediaries.  Those  handling physician claims are called carriers. 
METHoDs 
In September  1995, we surveyed 1244 randomly selected  Medicare  beneficiaries.  We 
initially selected  1300 beneficiaries  for whom  Medicare  Part B claims had been  filed in 
Calendar  Year  1994.  However,  we dropped  56 beneficiaries  from  our sample because 
22 questionnaires  were undeliverable  and 34 beneficiaries  were  deceased.  This 
reduced  the sample  size from  1300 to  1244.  Appendix  A contains our questionnaire 
and beneficiaries  responses  to the questions. 
Based  upon  previous  experience  with similar client and beneficiary  surveys, the sample 
size of  1300 beneficiaries  was calculated  to produce  an estimate within 3.5 percent  of 
the true value at the 95 percent  confidence  level.  We  used standard equations  for 
estimating sample  size with a binary response  variable. 
Beneficiary  participation  in the survey was voluntary.  A total of 942 beneficiaries 
returned  completed  questionnaires,  for a response  rate of 76 percent.  Given  the size 
of our sample  and response  rate, results of our survey are protectable  to the universe 
of 37.6 million Medicare  beneficiaries. 
Percentages  in the report  are based  on the number  of beneficiaries  answering each 
question.  Appendix  B presents an analysis of respondents  and non-respondents. 
1
 In 1989,21991,31993,4  and 19945 we conducted  similar national surveys of Medicare 
beneficiaries  to assess their awareness of and satisfaction with various aspects of the 
Medicare  program. 
The  majority of questions used in the 1995 survey were  used in our  1993 and 1994 
surveys.  Therefore,  Medicare  beneficiary  responses  in 1993, 1994, and 1995 are 
comparable.  The  1993, 1994, and 1995 surveys were  also similar to the 1989 and 1991 
surveys.  However,  some  questions were worded  and sequenced  slightly different. 
Additionally,  we provided  more  response  options  to questions in the 1993, 1994, and 
1995 surveys than we did in the 1989 and 1991 surveys.  Therefore,  we cannot 
compare  beneficiary  responses  in each of the five sumey years for all questions. 
However,  we did make comparisons  whenever  possible,  and determined  significant 
differences  in responses  through use of a t-test. 
----- ----- ---
We  conducted  this inspection  in accordance  with the QuaMy  Standards  for  Inspections 
issued by the Presidents  Council  on Integrity and Efficiency. 
2
 FINDINGS

BENEFICIARIES  REPORT  Posm  EXPERIENa  WITH  THE  MEDICARE 
PROGRAM 
Overall, beneficiaries  were  positive about  several aspects of the Medicare  program. 
They said they understood  the program  and can get information  when they need  it. 
Most beneficiaries  areaware  ofanduse  pafiicipating  physicians.  And,  most 
beneficiaries  who  had called their carriers were  at least generally satisfied with the 
service they received,  although over half of them cited problems  when calling. 
Eighty percent  of the beneficiaries  said that the Medicare  program  is understandable. 
This is about  the same as in 1994 when 79 percent  said the program  was 
understandable.  Figure  1 shows the level of understanding over the 5 years we have 
surveyed Medicare  beneficiaries. 
FIGURE  1 
BENEFICIARIES  UNDERSTAND 
THE  MEDICARE  PROGRAM 
PERCENT 
~ 
90

I  7Q  7fi  80 I 
80 
70 
60 
50 
40 
30 
20 
10 
n 
1989  1991  1993  1994  199s 
YEAR 
3
 Benejkhtiix tin  Get Needed Inf~tion 
Getting General  Information:  Seventy-eight percent  of the beneficiaries  said they 
could  get general information  about  Medicare  when they needed  it.  This is about  the 
same percent  of beneficiaries  who believed  they could  do so in 1994.  Table  1 shows 
the percent  of beneficiaries  who  said they can get general information  over the last 3 
years. 
TABLE  1 
BENEFICIARIES  CAN  GET  GENERAL  INFORMATION 
Yes  I  72%  I 75%  I  78%  I 
No  7% 5%  5% 
Dont  Know  21%  20%  17% 
Getting  Specific  Information:  Seventy-one  percent  of the beneficiaries  who  have 
needed  specific  information  about  their Medicare  coverage  said they have been  able 
to obtain  it most of the time.  Table  2 shows that the percent  of beneficiaries  who 
could  get specific  Medicare  information  most of the time remained  high. 
TABLE  2 
BENEFICIARIES  CAN  GET  SPECIFIC  INFORMATION 
C&  @@MMATION  7 
G@  1989  ~  1994  I  1995 
.: 
Most  of the Time  58%  67%  60%  67?40  71% 
Some  of the Time  29%  23%  28%  23%  19% 
Seldom  or Never  13%  10%  12%  10%  9!Z0 
sources  of Information:  From  a list of possible  places people  might go to get answers 
if they have questions  about what Medicare  pays for, beneficiaries  were  asked to 
indicate which places  they would  go.  They could  check more  than one  source. 
Most beneficiaries  said they get Medicare  information  from  their physicians offices 
and the Medicare  Handbook.  Seventy percent  of all beneficiaries  said they would  go 
to their physicians offices.  This is an increase from  1994 when only 50 percent  of the 
beneficiaries  said they would  go to their physicians for Medicare  information.  Fifty-six 
percent  of the beneficiaries  surveyed in 1995 said they would  refer to the Medicare 
Handbook.  This  is about  the same percent  of beneficiaries  who  used the handbook  in 
1994. 
4
 MiNt Ben@&&s  Kiuw About Pazkipatingl%ysiciaras 
Medicare  has participating physicians who  agree to charge no more  than the 
Medicare  approved  amount.  Medicare  pays 80 percent  of the approved  amount.  A 
beneficiary  is responsible  for paying a deductible  and a 20 percent  coinsurance. 
Figure 2 shows that the number  of beneficiaries  who were  aware of participating 
physicians has changed  relatively little during the 5 years we have surveyed Medicare 
beneficiaries. 
FIGURE  2 
BENEFICIARY  AWARENESS  OF PARTICIPATING  PHYSICIANS 
PERCENT 
100 
go . ..........................................................ti ............................................................ 
w 
80  - ........77 .....................  ............. 
70  -. 
60  -. 
60  -. 
40  --
30  --
20  --
10 --
.n 
W30  W91  m93  1994  t996 
YEAR 
Figure 3 shows that beneficiaries  use of participating physicians in 1995 is the same 
as in 1994. 
FIGURE  3 
BENEFICIARY  USE  OF PARTICIPATING  PHYSICIANS 
PERCENT 
ao ....................................................................................................... 
t  71  m i 
198s  ml  lzzz  m94  W9s 
WAR 
Twenty-four  percent  of beneficiaries  we sumeyed  said they did not know if their 
physicians were  participating.  Seventeen  percent  said they did not know their 
carriers provided  information  on participating physicians. 
5
 Eighty-seven percent  of the beneficiaries  said they are at least generally satisfied with 
the way Medicare  carriers processed  their claims.  As Figure 4 illustrates, few 
beneficiaries  said they were  dissatisfied. 
FIGURE  4 
SATISFACITON  WITH  CLAIM  PROCESSING 
Very  Setiafied  48% 
Very  Dissatisfied  1% 
Clalm  Not  Paid  MI  2% 
Gen.  Dls8at1811ed  2% 
)Ither  8% 
&rnerally  Satlsfled  39% 
Figure 5 shows the number  of beneficiaries  expressing satisfaction remains high. 
However,  interpretation  of trends for the past 5 years should be  done  with the 
understanding that we changed  our survey instrument in 1993.  This change  could 
slightly affect the trend.  The  1993, 1994, and 1995 surveys had a response  option  that 
was not offered  in 1989 and 1991.  Also,  in 1989, when beneficiaries  could  file their 
own claims, we asked only those beneficiaries  who submitted their own claims about 
their satisfaction. 
6
 FIGURE  5 
TRENDS  IN BENEFICIARY  SATISFACTION  WITH  CLAIMS  PROCESSING 
PERCENT
1001 
93 
m  ..............................- .................. ....8..3.. ....................*  .......................Bz................. 
80 
.....................  .... ................  . . . ..........  .......... . . ..  ............... 
60  --
....................  .....................  ........ ... . . .  .....................  ............... 
70   
.....................  .....................  .....................  . ..................  ............... 
60   
................ ....  .................. ...  ...................  .... ..........  ...... ......... 
60  
40  .-.  .....................  .....................  .....................  .....................  ..............-
3(J ...  ........... .........  .....................  ....................  .. .. ............  ... ........... 
20  ..- .,.2.. ................. .....................  ....................  ............... 
w  12 
10 -
0 
t989  W91  f3Q3  1994  1935 
YEAR 
=  SATISFIED  =  DISSATISFIED  ~  NEITHERAJNWID  CLAIM 
Mast Ben@ciati  areSatkjiedwithCanierTelZphoneStwice 
About  16 percent  of the beneficiaries  we surveyed said they had tried to call their 
carriers.  Figure 6 shows that 85 percent  of those beneficiaries  who had called their 
carriers said they were  at least generally satisfied with the service they received  the 
last time they called. 
FIGURE  6 
SATISFACTION  WITH  CARRIER  PHONE  SERVICE 
Gen  Satisfied  50% 
ther  4% 
Dlssatlsfled  4% 
Issatisfied  7% 
\ / 
Very  Satisfied  35% 
7
 Figure 7 shows that the percent  of beneficiaries  who were  satisfied with carrier 
telephone  service in 1995 is about  the same as in 1994. 
FIGURE  7 
TRENDS  IN BENEFICIARY  SATISFACIION  WHEN  CAUING  CARRIERS 
PERCENT 
90 '--"-'--""-""-""-""""""-""--"--.--.8~-.--.--.--..-.--.--.--.--.----.-----..-..........a2------------------------------------------
------ ------------------ ......................  .................. 
70  --
60  -
~o 
40  . 
so  
. .. .. .. ........  .................. 
20   
10 ..  ......  .................... 
o 
1980  W91  lw3  1994  1s96 
YEAR 
=  SATISFIED  ~  DISSATISFIED  =  NEITHER 
BENEFICIARY  UNDERSTANDING  OF  AND  SATISFACTION  WITH CERTAIN 
MEDICARE  SERVICES  HAS  IMPROVED 
Compared  to  1994, beneficiary  understanding of and satisfaction with Medicare 
services improved.  The beneficiaries  are more  satisfied with claims processing, 
including the speed  with which carriers pay their claims.  Beneficiaries  also have a 
better  understanding in 1995 of home  health and hospital payments than in 1994. 
FewerBen@ciaties Iden@ied ChzhrLlS%c&g  Boblims 
Although  87 percent  of beneficiaries  are at least generally satisfied with claims 
processing,  some  had encountered  difficulties with the way Medicare  processed  their 
claims.  When  given a list of possible  reasons beneficiaries  might be dissatisfied, 19 
percent  of the beneficiaries  surveyed identified  one  or more  problems  with their last 
Medicare  claim.  However,  fewer beneficiaries  cited problems  in 1995 than in 1994 
when 30 percent  cited one  or more  problems. 
8
 Figure 8 shows claim processing  problems  beneficiaries  experienced  before  their 
claims were  paid.  Numbers  in the figure represent  the percent  of all beneficiaries 
surveyed. 
FIGURE  8 
BENEFICIARY  PROBLEMS  PRIOR  TO  PAYMENT  OF  CLAIMS 
10  ------- ..............................................................................
o 
Problem  Qetting  Claim  Statu8  Ciaim  payment  Taking  Too LonO 
=  f991  ~  19S3  ~  1994  ~  1$96 
Figure 9 shows claims processing  problems  beneficiaries  experienced  after their claims 
had been  paid.  Numbers  in Figure 9 represent  the percent  of all beneficiaries 
surveyed. 
FIGURE  9 
BENEFICIARY  PROBLEMS  AFTER  PAYMENT  OF  CLAIMS 
PERCENT 
~ 
30 
20  ................................................................................................. 
13 
rzzl  11
10 
0 
Understanding  Cisinm P~ymerrt  Undw~tmrding  Clmima  D.nisi  Undwatanding  EOM 
.......... .  . 
m  1991  Izza  1993  m  1994  lxx!  1996 
9
 More  Ben@cHa  Ezpras  Satisfactiimwithlhe Sped  of ClkimPayments 
Eighty percent  of beneficiaries  said Medicare  carriers pay claims quickly enough.  This 
is an increase from  1994, when 73 percent  expressed  satisfaction with the speed  of 
claims processing. 
In 1994, 32 percent  of the beneficiaries  who had received  home  health services said 
they did not understand what home  health services Medicare  had paid for.  This 
percent  decreased  to  11 in 1995. 
CERTAIN  MEDICARE  PROGRAM  SERVICES  WHICH  NEEDED 
IMPROVEMENT  IN 1994  CO NTINUED  TO  NEED  IMPROVEMENT  IN 1995 
Overall, beneficiary  understanding of and satisfaction with Medicare  program  services 
is positive.  However,  some  trouble  spots remain.  Our  1995 beneficiary  survey showed 
problems  with carrier telephone  services, second  surgical opinions,  physicians fees, 
appeals,  and hospital payments. 
neir
~ti  EqMienced  Di@ukly  calling Ciu7im 
About  16 percent  of the beneficiaries  surveyed had tried to call their carriers. 
However,  5 percent  of the beneficiaires  answering our question  said they had wanted 
to call, but did not have their carriers phone  number. 
While beneficiaries  who  called their carriers generally expressed  satisfaction, over half 
said they experienced  problems.  They had difficulty getting access to their carriers, 
using carriers automated  voice  systems, and getting answers once  they got through to 
the carriers. 
The beneficiaries  who had called their carriers were given a list of possible  reasons 
why they might have been  dissatisfied the last time they called.  They  could  cite as 
many problems  as they experienced. 
10
 Table  3 shows the number  of beneficiaries  experiencing  problems  over the last 3 years. 
TABLE  3 
BENEFICIARIES  WITH  PROBLEMS  CAUING  CNUUERS 
  YEAR  Ix3Nlqc-
HAVIiUG  ~R@LEMS 
I 
1993  50% 
1994  52$Z0 
1995  58% 
Getting telephone  access with carriers is difticult for beneficiaries.  In 1994, 26 percent 
of beneficiaries  who had tried to call their carriers had to call 3 or more  times to get 
through.  In 1995, 28 percent  said they had to try three or more  times.  Further, 3 
percent  were  unable to get through at all.  Table  4 shows that getting access to a 
Medicare  carrier is a continuing problem. 
TABLE  4 
CALLING  CARRIERS 
r-
::lqJIi@lgl  OF  ~.  1- 1  1~  1~~ 
First Try  35%  46tZo  45% 
Second  Try  25%  24%  24% 
Three  or More  Tries  32%  26%  28?40 
Never Got  Through  8%  4%  3% 
Figure  10 illustrates the specific  type of problem  beneficiaries  had getting through to 
the carriers to get questions  answered.  Numbers  shown in the chart represent  the 
percent  of beneficiaries  who had called their carriers. 
11
 FIGURE  10 
BENEFICIARY  PROBIEMS  GETTING  THROUGH  TO  CARRIERS 
PERCENT 
100 
90 
80 
70  h"""--""-""---""'""""""-""-""-""-"""""-"""""-"--"--""-""-"""""-""-""""1"""""" """""""""""-""-""-"""""-"--""-" 
............................................................
00  K .  ...................................................... 
............................... 
60  ..4...s... ......... .. ................................
H. .........---.-..=...-...1-. .-..
40 
90 
20 
10 
0 
LINE BUBY  PUT  ON HOLD 
m  1989  m  1991  m  1993  Issl  1994  m  1995 
Using automated  voice  systems is difficult for some beneficiaries.  Thirty-seven percent 
of the beneficiaries  who had called their carriers reached  automated  voice  systems 
rather than carrier employees.  Table  5 shows that about  the same percentage  of 
beneficiaries  encountered  automated  voice  systems in 1995 as did in 1994. 
TABLE  5 
AUTOMATED  VOICE  SYSTEM 
*  -LED  BY:  1991  1993  1994  1995 
AUTOMATED  VOICE  235Z0  31%  36%  37% 
CARRIER  EMPLOYEE  77?Z0  699Z0  64%  63% 
Forty-four  percent  (23 of 52) of the beneficiaries  using automated  voice  systems in 
1995 said they encountered  problems  using the systems.  Although  this is less than in 
1994 when 73 percent  experienced  problems,  it still indicates a problem  for 
beneficiaries. 
Some  beneficiaries  experienced  other problems  after getting through.  Figure 11 shows 
the specific  problems  beneficiaries  experienced  after they got a telephone  connection 
with their carriers. 
12
 FIGURE  11 
BENEFICIARY  PROBLEMS  AFIER  GETTING  THROUGH  TO  CARRIERS 
PERCENT 
60 
40 
30 
20 
10 
0 
D;:?&REIEnlT  UN COURTEOU  8  AN~ER8  NOT  QUESTION 
UNDERSTOOD  UMAN6WCRED 
-1989  =  1991  Iiliizl 1993  m  1994  m  1996 
Mwt Ben@iiiries  WereNotAwarethatMdikare l%wkiesfor SecondStugicalOpiitiom 
In 1994, almost two-thirds (64 percent)  of all beneficiaries  surveyed were not aware 
that Medicare  pays for a second  opinion  on the need  for surgery.  Table  6 shows that 
60 percent  of the beneficiaries  sumeyed  in 1995 still did not know Medicare  paid for 
second  opinions. 
TABLE  6

SECOND  SURGICAL  OPINIONS

,
I
I 
19S  1991  1993  1994  1995 
I A 
UNAWARE  OF  SECOND  57%  59%  61%  64$Z0  60% 
SURGICAL  OPINIONS 
ManyBene@iati  WereNotAwarethatMedicareLi.mh P~sician Fees 
In our  1995 survey, we asked beneficiaries  if they knew Medicare  limits the fees that 
physicians can charge for specific  services.  Twenty-six percent  of the beneficiaries  did 
not know about  the limits.  This percent  is the same as in 1994. 
13
 Many Be@%h&s  WmNotAware  Of17ieirApIRig#m 
In 1994, 31 percent  of the beneficiaries  we surveyed did not know they could  appeal 
or request  a review of decisions  Medicare  carriers made  about  their claims.  In 1995, 
34 percent  lacked  such knowledge.  Table  7 shows that the number  of beneficiaries 
who  did not know they could  appeal  or request a review of their Medicare  claims has 
increased  every year since 1991. 
TABLE  7 
AWARENESS  OF  APPEAL  RIGHTS 
II
 I  II 
1989  24% 
II 
II  I 
1991  2270 
II  II 
1993  I  25% 
II

1994  I  31%  II 
II  1995  I  34%  II 
In 1995, 4 percent  of the beneficiaries  said they had appealed  a Medicare  decision  on 
their claims.  This response  was about the same in 1994 when 5 percent  said they had 
appealed  a decision. 
Some Bewfkiaries  Do Not UndkmtiuuAippealDeciions 
We  asked beneficiaries  who had appealed  about  their understanding of final decisions, 
and their opinion  about  the fairness of the decision.  Table  8 shows their responses. 
TABLE  8 
OPINIONS  ABOUT  APPEALS 
1993  1994   1=  .: 
I 
Thought  Appeal  Handled  Fairly  59%  62%  73% 
Understood  Final Decision  67%  76%  69% 
About  one-third  (32 percent)  of the beneficiaries  who  had appealed  said they were not 
satisfied with the time it took  to get a final decision  on their appeal. 
14
 some Bene@mA  Do  N&  UiukmandHmpitd Payments 
In 1994, 23 percent  of the beneficiaries  who had been  hospitalized  since covered  by 
Medicare  said they did not understand what hospital services Medicare  had paid for. 
In 1995, 19percent  said they didnotunderstand  hospital pa~ents. 
OTHER  PROGRAM  SERVICES  ALSO  NEED  IMPROVEMENT 
In our 1995 survey, HCFA  requested  that we ask beneficiaries  about  their awareness 
of certain Medicare  program  services that we had not included in our prior reports  on 
beneficiary  satisfaction.  The beneficiaries  we sumeyed  indicated  a need  for 
information  on four semices.  They are influenza immunizations, mammograms, 
hospice  care, and quality reviews by Peer Review  Organizations. 
Flu Immunizations:  Twenty-four  percent  of the beneficiaries  did not know Medicare 
paid for flu immunizations. 
M~()~~is  Twenty-four  percent  of the female  beneficiaries  surveyed did not 
know Medicare  paid for mammograms. 
Hospice  Care:  Forty-two  percent  of beneficiaries  did not know Medicare  paid for 
hospice  care.  Sixteen percent  did not know what hospice  care is. 
Peer Review  Organkmtions (PRO):  We  gave beneficiaries  a list of possible  places 
they might contact  if they had a concern  about  the quality of their health care, and 
asked them to check  as many as applied.  Only 2 percent  said they would  call their 
PRO.  Over half (57 percent)  of the beneficiaries  said they would  contact  the 
physician, hospital, or health care organization  that provided  the care if they had a 
concern  about  quality.  Nineteen  percent  said they would  call their Medicare  carrier. 
Two  percent  said they would  call their State Board  of Medical  Licensure  and State 
Insurance Commission.  Forty percent  of the beneficiaries  said they did not know who 
they would  call if they had a concern  about  quality of care. 
Over  three-fourths  (78 percent)  of the beneficiaries  surveyed did not know each State 
has a Medicare-funded  PRO  to monitor  the cost and quality of health care provided 
to Medicare  beneficiaries. 
15
 RECOMMENDATION 
As in previous years, beneficiaries  were positive  about the Medicare  program.  Most 
said they understand the program  and can get information  when they need  it.  Eighty-
seven percent  of the beneficiaries  said that they were  satisfied with the way carriers 
processed  their Medicare  claims.  Further, fewer beneficiaries  cited problems  with 
. 
claims processing  than in previous years. 
However,  some  particular problems  identified by beneficiaries  need  attention by 
HCFA. 
Tele~hone  SeMce 
Although  most beneficiaries  who  had called their carriers for assistance were  satisfied 
with the services they had received,  the number  experiencing  problems  when calling 
remains high.  Further, over one-fourth  (28 percent)  of the beneficiaries  had to call 
three or more  times to reach their carriers. 
Second  Surtical  OPinions 
Sixty percent  of the beneficiaries  surveyed did not know that Medicare  will pay for a 
second  opinion  on the need  for surge~. 
Phvsician Fees 
One-fourth  (26 percent)  of the beneficiaries  surveyed did not know Medicare  limits 
physicians fees for specific  services.  This is the same as in 1994. 
One-fourth  (24 percent)  of the beneficiaries  sumeyed  said they did not know they 
could  appeal  Medicare  decisions  about  their claims. 
FhI  hUIUniZatiOIlS  and MammOIZEUIM 
One-fourth  (24 percent)  of the beneficiaries  surveyed did not know Medicare  paid for 
flu immunizations. 
One-fourth  (24 percent)  of the female  beneficiaries  surveyed did not know Medicare 
paid for mammograms. 
We  recommend  that HCFA  develop  a plan for improving beneficiary  satisfaction and 
understanding  in the trouble  areas mentioned  above. 
16
 AGENCY  COMMENTS 
The  HCFA  Administrator  commented  on our report,  and concurred  with our

recommendation.  He  reported  that HCFA  has implemented  new Contractor

Performance  Evaluation procedures  that allow regional offices  to expand  their reviews

to include customer  service areas that need  special attention, such as telephone

service.  Further, the new procedures  ensure that beneficiary  input is incorporated  into

reviews.  The  HCFA  is also revising letters to beneficiaries  to improve  the clarity of

information  about  appeals.

Appendix  C shows the full text of the comments  provided  by HCFA.
 EN DNOTES

1.	 Health  Care Financing Administration,  United  States Department  of Health 
and Human  Services, HCFA  Statistics, September  1995. 
2.
 Office of  Inspector  General,  United  States Department  of Health  and Human 
Services.  A Survey of Medicare  Beneficiary  Satisfaction.  0AI-04-89-89040. 
3.	 Office of Inspector  General,  United  States Department  of Health  and Human 
Services.  Medicare  Beneficiary Satisfaction:  1991.  0EI-04-90-89030. 
4.
 Office  of Inspector  General,  United  States Department  of Health  and Human 
Services.  Medicare  Beneficiary Satisfaction:  1993.  0EI-04-92-O0480. 
5.
 Office  of Inspector  General,  United  States Department  of Health  and Human 
Services.  Medicare  Beneficiary Satisfaction:  1994.  OEI-04-93-00150. 
18
 APPENDIX  A

RESPONSES  TO  1995  SURVEY  OF  MEDICARE  BENEFICIARY 
SATISFACTION 
	 Not  every respondent  answered  every question.  Percentages  are based  on 
actual responses.  The  number of respondents  not answering an individual 
question  is not included in the calculation of percentages. 
For  Questions  10, 11, 12, 14, 21, and 25, respondents  could  check more  than 
	
one  choice.  The  sum of the percentages  will total more  than 100. 
Question  Responses  Percentage 
PART  1:  MEDICARE  COVERAGE 
1.  In gene@  do you think... 
a.  The  Medicare  program  is understandable? 
Yes  724  80 
No  181  20 
Not Answering:  37 
b.  You  can get information  about  Medicare  when you need  it? 
Yes  718  78 
No  48  5 
Dont  Know  155  17 
Not Answering:  21 
c.  Medicare  pays your claims quickly enough? 
Yes  728  80 
No  82 9 
Dont  Know  103  11 
Not Answering:  29 
A-1(cid:31) Question  Reqxmses  Percentage 
2	 Thinkingabout  the last time you were  a patient  in a homitzd for at bst  one 
nigh~ was it clear  to you what Medicare  paid for? 
(Check  ~  answer.) 
I have not been  in the 
hospital for at least 
one  night since I have 
had Medicare.  318  35 
Yes,  it was clear what 
Medicare  paid for.  398  43 
No,  it was @  clear what 
Medicare  paid for.  114  12 
I do not remember  if it 
was clear what Medicare 
paid for.  80  9 
Medicare  has not yet paid 
the hospital.  10  1 
Not Answering:  22 
---------------------------- ------------------------- -------------------------------- ---------------------------- ---.-
3.	 Think about  the last time you were  a patient  in a hospital for at least one 
night. 
Were  you given written information  that said you have a right to request  a 
review if you think the hospital is forcing you to leave before  you are well 
enough? 
(Check  one answer.) 
I have not been  in the 
hospital since I have 
had Medicare.  303  34 
Yes,  I was given written 
information  about  my 
right to request  a review.  207  23 
No,  I was not given written 
information  about  my 
right to request a review.  186  21 
I dont  remember.  208  23 
Not Answering:  38 
A-2(cid:31) Question  Responses  Percentage 
4.
 Have  you ever  received  services in vour home  from  a home  health a~ency in 
the last year? 
Yes  139  15 
No  (Skip to Question  6)  775  85 
Not Answering:  28 
................................................................. -----------------------------------------------------
5.	 Thinking about  the mo6t rexxmt time you received  medical  seMces  in vour 
home  from  a home  health aizency, was it clear  to you what Medicare  paid for? 
Yes,  it was clear what Medicare 
paid for.  103  77 
No,  it was @  clear what 
Medicare  paid for.  15  11 
I do not remember  if it was 
clear what Medicare  paid for.  14  11 
Medicare  has not yet paid for 
the home  health services.  2 1 
Not Answering:  4 
------------------------- -------------------------- -------------------------- -------------------------- ---------------
6.  Before  today, did you know that Medicare  pays for flu shots (immunizations)? 
Yes  709  76 
No  221  24 
Not Answering:  12 
--------------------- ------------------------- --------------------------- ----------------------------- ---------------
7.  Before  todav,  did you know that Medicare  pays for mammojyams  (breast  x-
rays to detect  cancer)? 
&l  Females 
Yes  639  399  (76%)  70 
No  279  129  (24%)  30 
Not Answering:  24 
8.  Before  today,  did you know that Medicare  pays for hospice  care? 
Yes  392  42 
No  386  42 
I dont  know what 
hospice  care is.  151  16 
Not Answering  13 
A-3(cid:31) Question  Responses  Percentage 
9.
 Before  today, were you aware  that your State  had a Medicare-funded  Peer 
Review  Orga.nintion  (PRO)  to monitor  the cost and quality of care  provided 
to Medicare  recipients?  (The  purpose  of Peer  Review  Organizations  preceded 
the question.) 
Yes  203  22 
No  711  78 
Not Answering:  28 
------------------------ ---------------------- --------------------------- ----------------------------- ----------------
10.	 In the pas~ if you had a concern  about  the quality of your medical  care,  whom 
did you call?  (Check  all that apply.) 
(N  =  892- Number  Responding  to Question) 
I did not have 
a concern  491  55 
I did not know who 
to call  151  17 
Insurance company  that 
pays Medicare  claims  75  8 
Medicare  PRO  10  1 
State Board  of 
Medical  Licensure  11  1 
State Insurance Commission  5 1 
Hospital  or organization 
that provided  care  123  14 
Doctor  that provided  care  180  20 
Not Answering:  50 
--------------------------- ---------------------- -------------------- ------------------------- .. 
11.  What types of medical  insurance do you or your spouse  have in addition  to 
Medicare? 
(N=  800- Number  Responding  to Question) 
Do  not have additional 
insurance coverage  132  17 
Medicaid  94  12 
Health insurance through your 
or your spouses  current or 
former  employer  338  42 
Private Medicare  supplement  256  32 
Other  3  1 
Not Answering:  142 
A-4
 Question  Responses  Percentage 
PART  2  GEITING  INFORMATION  ABOUT  MEDICARE 
12
 Where  would you go to get information  about what Medicare  pays for? 
The  following are  some  places people  might go to get answers if they have 
questions about what Medicare  pays for.  (Check  all that  apply.) 
(N=  908- Number  Responding  to Question) 
Your  doctors  office  632  70 
Friend or relative  104  11 
AARP  or other 
membership  organization  126  14 
Insurance company  that 
processes  your Medicare  claims  367  40 
Medigap  insurance company  209  23 
Social Security office  299  33 
Local  senior citizens group  58  6 
Insurance salesperson  27  3 
Medicare  Handbook  506  56 
Medicare  Peer Review 
Organization  (PRO)  38  4 
Your  States ICA  26  3 
Not Answering:  34 
13.
 Think of when you needed  specific information  about what Medicare  pays for, 
how often were you able to get the information  you needed? 
(Check  ~  answer.) 
Most  of the time  391  44 
Some  of the time  105  12 
Seldom  or never  51  6 
I have never needed  information  348  39 
Not Answering:  47 
A-5(cid:31) Question  Responses  Percentages 
14.
 Listed below are  Medicare  booklets  that you can obtain free  of charge.  Please 
check  the booklets you were  aware  of before  today. 
(N=  942- Number  Responding  to %uvey) 
Guide  to Health Insurance for 
People  with Medicare  249  26 
Guide  to Choosing  a Nursing Home  69  7 
Medicare  Coverage  for Second 
Surgical Opinion  67  7 
Medicare  Hospice  Benefits  75  8 
Medicare  and Coordinated 
Care Plans  43  5 
Medicare  and Other Health Benefits  173  18 
Medicare  and Home  Medical 
Equipment  93  10 
How  to Help  Medicare  from Being 
Ripped  Off  81  9 
15.
 Do you know how to obtain the free booklets? 
(Instructions  for ordering were  provided.) 
Yes  227  25 
No  672  75 
Not Answering:  43 
PART  3:  MEDICARE  CLAIMS 
16.
 Did you know before  today that Medicare  limits how much doctors  can charge 
you for specific semices? 
Yes  658  74 
No  233  26 
Not Answering:  51 
A-6
 Question  Responses  Percentages 
17.
 Did you know before  today that your doctors  are  supposed  to file your 
Medicare  claims for you? 
Yes  854  93 
No  69 7 
Not Answering:  19 
---------------------------------- ----------------------- ----------------------------------------------- --------------
18.
 Ove@  how satisfied are you with the way Medicare  has processed  your 
claims? 
Very  Satisfied  438  48 
Generally  Satisfied  360  39 
Neither Satisfied nor Dissatisfied  73  8 
Generally  Dissatisfied  17  2 
Very  Dissatisfied  11  1 
Medicare  has not yet paid claim  16  2 
Not Answering:  27 
-------------------- ---------------------------- ----------------------- ---------------------------- -------------------
19.	 Did you have any of the following problems  the last time you had a Medicare 
claim for a doctors  visit? 
(Check  as many as apply.) 
(N=  861- Number  Responding  to Question) 
I had difficulty getting information 
on the status of my claim.  10  1 
I did not understand what part of 
my claim Medicare  paid and why.  55  7 
I did not understand why Medicare 
denied  the claim.  27  3 
Medicare  took  too  long to pay.  36  4 
I did not understand the notice 
Medicare  sent (EOMB).  28  17 
I did not have a problem  with my 
Medicare  claim.  699  81 
Other  6 1 
Not Answering:  81 
A-7
 Question  Responses  Percentages 
PART  4  CMLING  MEDICARE 
20.	 Have  you ever  tried to call the insurance  company  that processes  your 
Medicare  claims? 
Yes  140  16 
No,  Have  not needed  to call  699  79 
(skip  to Q-25) 
No,  Wanted  to call, but do not 
have telephone  number  43  5 
(skip  to Q-25) 
Not Answering:  60 
21.	 Thinkingabout  the last time you tried to @  how many tries did it take you to 
reach  them? 
(N=  140- Number  Who  Had  Called Carrier) 
First Try  59  45 
Second  Try  32  24 
Three  or More  Tries  37  28 
Never  Got  Through  4  4 
Not Answering:  8 
------------------------- ------------------------ ------------------------- ---------------------------- ----------------
22.  How  satisfied were you with the seMce  you received  the last time you called? 
(N=  140- Number  Who  Had  Called Carrier) 
Very  Satisfied  47  35 
Generally  Satisfied  69  50 
Neither  Satisfied nor Dissatisfied  6  4 
Generally  Dissatisfied  6  4 
Very Dissatisfied  10  7 
Not Answering:  2 
A-8(cid:31) Question  Responses  Per=ntages 
23.	 Listed below are  Possible problems  someone  might have when calling the 
Medicare  insurance  company.  Did you have  any problems  the last time you 
called?  (Cheek  as manv as ardy.) 
(N=  140- Number  Who  Had  Called Carrier) 
Line was busy  59  45 
Had  problems  with automated 
voice  system  23  18 
Person  answering the call 
was not very courteous  4 3 
Put on hold too  long  34  26 
Was not able to get question  answered  11  8 
Could  not understand the answer 
they gave me  6 5 
Got  different  answers from 
different  people  33  13 
I did not have a problem  with 
the semice  I received  55  42 
Not Answering:  10 
-------------------- ------------------------- ------------------------- ----------------------------- -------------------
24.	 Some  Medicare  insurance  companies  use an automated  voice  system to handle 
telephone  calls.  Thinking about  the last time you cane@  how was your call 
answered? 
(N=  140- Number  Who  Had  Called Carrier) 
By an automated  voice  52  37 
By a Medicare  employee  88  63 
Not Answering:  O 
PART  5:  APPEALING  CLAIMS 
25.	 sometimes  people  disagree  with the decisions made  on their Medicare  claims. 
When  this happe~  you may appeal  or request  a review of those  decisions. 
Did you know before  today that you could appeal  or request  a review? 
Yes  604  66 
No  305  34 
Not Answering:  33 
A-9
 Question  Responses  Percentages 
26.	 Have  you ever  appealed  a decision made  by Medieare  on a claim you 
submitted? 
Yes  31  4 
No  (Skip to @31)  850  96 
Not Answering:  61 
--------------------------- -------------------------- ----------------------------- --------------------- ---------------
27.	 How  soon  after Medieare  made  the decision  on your claim did you file your 
appeal? 
(N=  31- Number  Who  Had  Appealed) 
Within  1 month  17  61 
Within 3 months  9  32 
Within 6 months  2  7 
Not Answering:  3 
---------------------------- ------------------------ --------------------- ------------------------ ---------------------
28.	 Were  you satisfied with the length of time it took  to get a final deeision  on 
your appeal? 
N  =  31- Number  Who  Had  Appealed) 
Yes  19  68 
No  9 32 
Not Answering:  3 
------------------------------ -------------------- ------------------------- --------------------- ----------------------
29.  Did you understand the final deeision made  on your claim? 
(N=  31- Number  Who  Had Appealed) 
Yes  20  69 
No  9 31 
Not Answering:  2 
30.
 Do you think your appeal  was handled fairly? 
(N=  31- Number  Who  Had  Appealed) 
Yes  22  73 
No  8 27 
Not Answering:  1 
A-10
 Question  Responses  Percentage 
PART  6  GEITING  SECOND  OPINIONS 
31.
 If your  doctor  recommends  that you have surgexy, Medicare  will help you pay 
to get the opinion of another  doctor  to make  sure the surgery is really 
neeeswy.  Were  you aware before  today that Medieare  would help to pay for 
you to get a seeond opinion before  having surgery? 
Yes  367  40 
No  550  60 
Not Answering:  43 
--------------------- ----------------------- ---------------------- --------------------- --------------------------- ----
32  Thinking about  the last time you had non-emergeney  surgery, did you get a 
second  doctors  opinion before  having the surgery? 
Yes  125  14 
No  366  41 
I have never had non-emergeney 
surgery  404  45 
Not Answering:  47 
---------------------- -------------------------- -------------------------------- --------------------------- -----------
33.	 Now that  you know Medicare  will help you pay for a second  doctors  opinio~ 
how likely are you to get a seeond opinion should you need  non+mergeney 
surgery? 
Likely to get second  opinion  709  80 
Not likely to get second  opinion  181  20 
Not Answering:  52 
PART  1  PARTICIPATING  IXXXORS  PROGRAM 
34.	 Medieare  has participating doctors who agree  to charge  no more  than 
Medieares  approved  amount.  Mediea.re pays 80%  of the approved  amount. 
You  are  only responsl%le for paying the deduetiile  and the 20%  coinsurance. 
Before  todav,  had you ever heard  about Medieare  participating doctors? 
Yes  735  80 
No  186  20 
Not Answering:  21 
A-n  Question  Responses  Percentage 
35.  Are  any of your doctors  participating doctors? 
Yes  653  71 
No  52  5 
Dont  Know  219  24 
Not Answering:  18 
36.
 Have  you ever  eontaeted  the insurance  company  that processes  your Medieare 
claims to get the names  of doctors  who are  participating doetors?n 
Yes  56  6 
No  709  77 
I did not know I could get this 
information  from  the insurance 
company  that processes  my claims  156  17 
Not Answering:  21 
--------------------------- --------------------------- --------------------------- ------------------------ ------------
37.  Thinking about  the future,  how likely are you to seleet a participating doctor 
for health care  seMees? 
Likely to select 
participating doctor  611  69

Not likely to select 
participating doctor  70  8

Will not matter if doctor 
is participating  202  23

Not Answering:  59 
A-12
 APPENDIX  B

ANALYSIS  OF  RESPONDENTS  VS. NON-RESPONDENTS 
A consideration  in surveys of this type is that the results maybe  biased  if non-
respondents  are significantly different from  respondents.  To  determine  whether 
significant differences  exist in this survey, we performed  various analyses, including a 
comparison  of  age and gender  for the 942 respondents  and the 302 non-respondents. 
The  analyses revealed  no significant difference,  which suggests that our survey results 
were not biased. 
ANALYSIS  BY  AGE 
The  average  age for respondents  was 72, compared  to age 73 for non-respondents.  A 
means test revealed  that the difference  in average ages for the two groups was not 
statistically significant. 
ANALYSIS  BY  GENDER 
A chi-square  analysis of gender  showed  that the distribution of male and female 
respondents  was comparable  to the distribution of non-respondents. 
S&mm  REsPoNJy3NTs  NON-RESPONDi3NIS  \ 
I 
40%  43%  39% 
FEMALE  60%  57%  61% 
ANALYSIS  BY  TIME  OF  RESPONSE 
As  an additional  guard against obtaining biased  results, some  sumeys similar to this 
one  are reviewed  for differences  which may exist between  early and late responses. 
The  rationale  is that late respondents  and non-respondents  may share certain 
tendencies.  For  example, when compared  to early respondents,  late respondents  could 
hold more  negative (or,  at least, less enthusiastic) opinions. 
To  analyze for potential  bias related to time of response,  the first 719 responses  (76 
percent)  were  compared  to the last 223  responses.  We  then performed  a t-test on 
each groups  responses  to three key questions  on the questionnaire  (Questions  la,  lb, 
and  lc).  Those  three questions,  posed  to all respondents,  relate to program 
understandability,  availability of information,  and claims processing  quickness.  The 
early responses  to the key questions were,  cumulatively, 79.0 percent  positive.  The 
later responses  were  79.3 percent  positive.  Based  on the t-test, this difference  is not 
statistically significant. 
B-1
 APPENDIX  C 
HCFA  COMMENTS 
c-1