Departent of 
Health and Human Servces

OFFICE OF

INSPECTOR GENERAL

MEDICARE BENEFICIARY SATISFACTION:

1991

4t 
Richard P. Kusserow 
INSPECfOR GENERA 
ocBER 
1991  GEN

OFFCE OF INSPECfOR 
The miion of the Offce of Inpeor General (OIG), as mandated by Public Law 95-452, as
amended is to protet the integrty of the Deparment of Heath and 
Human Servce' (HS)
program as well as the heath and welfare of beneficiares 
served by thos programs. 
statutory miion is caed out though a nationwide network of audits, investigations, and 
inpetions conducted by thee OIG operatig components: the Offce of Audit Servce, the
Offce of Inestigations, and the Ofce of Evaluation and Inpetions. The DIG al inorm 
the Sereta of HHS of program and management problems, and recmmends cour 
correc them.

OFFCE OF AUDIT SERVICE 
sece 
The OIG's Offce of Audit Servce (OAS) provdes al auditig  for HHS, either by
conducteinxg aeud its with its ow audit resurce or by oversing audit work done by others. 
Audits  the performance of HHS program and/or its  contractors in 
cag  respee  grante and 
out their  responsibilties and are intended to provide independent
asments of HHS program and operations in order to reduce waste, abus, and
mimanagement and to promote ecnomy and effciency thoughout 
the Department. 
INGATIONS 
OFFCE OF 
cral, ci 
The OIG's Ofce of Investigations (01) conduct  and admtrative 
investigations of alegations of wrongdoing in HHS programs or to HH beneficiares and of 
unjust enrchment by provders. The investigative effort of 01 lead to cral convictions 
admiistrative sanctons, or ci money penalties. The 01 al overs State Medcad fraud 
proste 
control units which investigate and  fraud and patient abus in the Medcad program. 
AN 
OFFCE OF EVALUATION  INSPECfONS 
The OIG's Offce of Evaluation and Inpetions (OEI) conducts short-term management and 
program evaluations (caed inpetions) that foc on isues of concern to the Department, 
the Congres, and the public. The fidigs and recmmendations contaied in thes inpetion 
report generate rapid, accrate, and up-to-date inormation on the effciency, wlnerabilty, 
and effectivenes of deparmental program. 
Th  Jes 
report was prepared in the Atlanta Regional Offce under the diection of  J. Flowers 
Regional Inpetor General, and Ch Koehler, Deputy Regional Inpetor General, Offce of 
Evaluation and Inpeions. Project sta: 
ASTE 
ATLA 
RUSS AN 
Prject Leader  Wm. Mark Krhat, MPH  J. Robert Rus, Ph. 
Betty Apt, 

Tedes 
Pegg DaTnel,o 
 wl  Lead Analyst  Barbara  Daniel Craig Lokhart Ph. 
Joe  Brian Ritchie  Jance S. Rogan, Ph.D.
Chtopher Angl 
Vicki Greene 
Kiberly Graves 
Paulett Robert Monroe  ... .. .- -
Department of Health and Human Servces 
OFFICE OF

INSPECTOR GENERAL

MEDICARE BENEFICIARY SATISFACTION:

1991

W2' 
Kusserow 
Richard  P. 
INSPECfOR GENERA  EXECUTIVE  SUMMAR 
PUR 
Ths surey of Medicae beneficiaries was conducted to assess 
beneficiar experience 
and satisfaction with varous aspects of the Medicare program. 
BACKGROUN 
The Offce of Inspector General (OIG) for the Department of Health and Human 
Servces (HHS) has conducted a survey of a random sample 'of Medicare beneficiaries. 
Parcipation in the survey was voluntary and yielded a response rate of 83 percent. 
Responses were compared to those of a 1989 OIG survey to determine if there were 
signcant diferences. 
FIINGS 
Ths survey of Medicare beneficiaries found that: 
Overall, beneficiaries appear very satisfied with Medicae. 
thi 
nie 
Seventy- percent say they  the program is understandable--a 
percentage which is signcantly higher than in 1989 when 73 percent 
thought the program was understandable. 
Seventy-four percent understand the payment policies compared to 69 
percent in 1989.

Ninety percent of the beneficiaries can get inormation about Medicare 
when they need it-a signcant improvement over the 85 percent in 
1989. 
Ninety-three percent are satisfied with the way Medicare processes their 
claim. In 1989, onl those beneficiaries who submitted their own claim 
were polled, and 88 percent were satisfied. 
caer 
Eighty-four percent of those who have caed their  were satisfied 
with the servces they received. In 1989, 80 percent of those who caed 
caers
' toll-free numbers were satisfied with the servces they received.  However, beneficiaries did experience some problems with Medicare servces. 
Two-thids (67 percent) identifed one or more problems 
they had
experienced, such as understanding what Medicare paid on their claims 
and why (38 percent). 
Eighty-two percent of the callers identifed problems, particularly with 
the lie being busy (53 percent) or being put "on hold" too long (43

percent). 
Few beneficiares are aware of or use the 
special servces Medicare offers, such
as hospital mortalty data and nursing home inspection reports. Ths fiding is
simar to 
that of the 1989, survey. ..................................................................................................... ................ 
. . . . . . .. 
.... .......  ........  .......  ........  ....... . .......  ....... . .......  .......   ..  ..  ..  ..  ..  ..  ..  ..  ...   ...   ...   ...   ...   ... .   ...   ...   ...   ...   ...   ...  .  ...   ...   ...   ...   ...   ...   . ..  ..  ..  ..  .. .  ..  ..  ..  ..  . ..  . . . ., .  '., ..  '",-
TABLE OF CONTENTS

EX 
SUY 
INODUcrON. 
Purose. 
Background 
Methods  . . . . . . . . . . . . . . . . . 2 
...................................................... 4

FIINGS 
Overal Understading of the Medicare Program  . . . . . . . . . . . . . . . . . . . . . . . 4 
How Beneficiaries Get Inormation
 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Satisfaction with Oaims
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .gnissecorP
Satisfaction with Caers' Telephone Servces. . . . . . . . . . . . . . . . . . . . . . . . . . 
Use of Special Servces Offered by Medicare 
ENNaI 
APPENIX 
Appendix A: Method and Sample Selection  . . . . . . . . . . . . . . . . . . . . . . .. A-
Appendix B: Responses to 1991 Surey of 
Medicae Beneficiar Satisfaction  . . . . . . . . . . . . . . . . . . . . .. B-
Appendi C: Comparson to the 1989 Survey. . . . . . . . . . . . . . . . . . . . . . .. C-
Appendi D: Analis of Respondent vs. 
Non-Respondents 
Appendi E: Problems with Telephone Servces. . . . . . . . . . . . . . . . . . . . .. E-
Oai 
and  Processing 
f;,,  INTRODUCTION 
PUR 
Ths surey of Medicare beneficiaries was conducted to assess beneficiary experience 
and satisfaction with various aspects of the Medicae program. 
Responses were also compared to a 1989 Ofce of Inspector General (OIG) national 
determe if there were significant diferences. 
survey to 
BACKGROUN " 
Medar 
Medicae is a Federal health insurance program for individuals age 65 and older and 
for certn categories of disabled people. Authoried in 1965 by title XVII of the 
Social Securty Act, Medicare serves approxiately 33 mion people, known as 
beneficies In 199, Medicae paid benefits totallg $105 billion. 
The Medicae program has two part. Part A (hospital insurance) helps pay for 
inpatient hospital cae, some inpatient care in a skied nursing facilty, skilled home 
health care, and hospice care. A person entitled to Medicare automaticall receives 
' servces, outpatient 
thi coverage. Part B (medical insurance) covers physicians
hospital servces, and other medica servces and supplies. Part B is optional. 
Beneficiaries desirg this coverage pay a monthly premium. Both Part A and Part B 
have deducttble and coinsurance requirements. Beneficiaries must pay these either 
out of poket or through supplementa insurance coverage. 
The Health Cae Financing Admistration (HCF A) withi the Department of Health 
and Human Servces (HHS) has responsibilty for the Medicare program. However, 
other organtions share in the program s administration. The Social Security 
Admitration (SSA) establishes eligibilty, enrolls beneficiaries in the program, and 
collects the premium for Par B coverage. Priate health insurance companes 
contract with the Federal Governent to servce claims for Medicae payment. 
intermedes 
Inurance companies that handle Par A claims are called  Those 
caeo. 
handlg Par B claim are called  Chge 
Recen 
The Medicare program is continually undergoing change. In recent years Congress
has passed and repealed the Catastrophic Health Care Coverage Act, which would 
have imposed the most far-reachig changes to Medicare since its inception. Other 
legislation requires that physicians and other providers submit al Medicare claims for 
beneficiares. In addition, HCF A has implemented changes aimed at better servce for 
beneficiares. Among them is the introduction of an automated telephone system for
the caers in some States. 
Stu 
Relate 
In 1989, the Inspector General conducted a national survey of Medicare beneficiaries 
to assess their awareness of and satisfaction with various aspects of the Medicare 
program. The report was entitled "A Survey of Medicare Beneficiary Satisfaction 
(OAI-0489-8900). As a result of that study, HCFA requested that the Inspector 
General conduct simar surveys of beneficiaries in Georgia! and New Jerser--States 
where there had been report of beneficiary dissatisfaction with the Part B carrers. 
MEODS 
SUley 
1991 
A survey instrument composed of 47 questions was mailed in December 199 to 637 
randoml selected beneficiaries for whom Medicare Part B claims had been 
fied in 
Caendar Year 1989. Their paricipation in the survey was voluntar. 
eliated 
Nine beneficiaries were  from the sample for various reasons: five 
questionnaires were undelierable, two beneficiaries were deceased, and two 
indivdua had been erroneously selected. Ths reduced the sample size from 637 to 
628. 
A tota of 519 beneficiares retued completed questionnaies, for a response rate of 
83 percent. (See appendix A for additional 
inormation on methods used in this 
survey. 
Con 
Suey 
to 
The majority of the questions in thi survey were also used in the 1989 OIG survey, 
though in some intances there were slight diferences in the wording and sequencing 
of the questions. Where applicable, responses to the surveys were compared to 
determe if diferences were statistica signcat. For purpses of this survey, 
signcat" dierences refer to those which were determed, using the t-test, to be  substantial. Instances where 
such differences were calculated are noted in the 
Findings section of thi report. (See appendix B for responses to 
al questions in this
survey and appendix C for a comparson 
of the two surveys.  ''' ..- _ -:_-;";::::":; - -
FINDINGS

Th 
survey of Medicare beneficiaries found that: 
Overal beneficiaries appear very satisfied with Medicare. 
thi 
Seventy-nie percent say they  the program is understandable, a 
percentage which is signcantly higher than in 1989. 
Seventy-four percent understand the payment policies. 
Ninety percent can get inormation when they need it. 
processes their 
Ninety-three percent are satisfied with the way Medicare 
Eighty-four percent of those who have called their carrer were satisfied 
with the servces they received.

, such as 
Few beneficiaries are aware of the special servces Medicare offers
report. 
hospital mortality data and nursing home inspection 
Approxiately 66  themselves to be in good 
percent of the respondents consider 
health, and 81 percent have medical coverage in addition to Medicare. 
BENCI 
UNERAN TH MEICAR PROGRA 
MOS 
thi 
Over three-fourths (79 percent) of the beneficiaries  the Medicare program is 
understandable. Statisticall, thi rate is signficantly higher than on the previous 
surey, when 73 percent thought the program was understandable. The repeal of 
the last survey could have contributed toward more

catatrophic coverage since 
favorable responses.

Seventy-four percent of the beneficiares understand Medicare s overall payment

policies, compared to 69 percent in 1989.
 ~~~~
. .. ",_._ - - """- . -
they understand what 
Of the beneficiares who have been hospitalied, 79 percent say 
Th response is also signifcatly higher than the rate in 1989, 
Medicare paid for. 
when onl 67 percent understood their hospital coverage. 
BETER 
BENEFICIARIES UNDERSTAND PROGRAM 
100 
Legend 
79%  79%  1989 
111991 
Prra  Pa Po Ho Cove 
UNDERSTANDABLE 
Thee-fourths of the beneficiaries who received home health servces understand 
payments for those servces. 
BENCI CA GET INORMTION WH NEED. 
Medicae when 
Ninety percent of the beneficiares say they can get inormation about 
Th  signcat 
they need it.  response is a  improvement over the 85 percent who gave 
that respons in 1989. 
A thid of  have never needed to get specifc inormation 
the beneficiares say they 
about their Medicae coverage, but of those who have needed such inormation, 67 
most of the tie. Th is signcatly higher than in 
p1er9ce8nt9 w,er ew ahblee tno  g5et8 h eplp e
 rcent were able to get help most of the time. 
C.
F:-:;  ':""' . , ,,, ,,.
MORE BENEFICIARIES CAN GET INFORMATION 
100 
90%  Legend 
1989 
1991 
Ge  ft 
Ca Ge  Can GeOt 8f  Inf.
Info.  Mo  Time 
From a lit of possible inormation sources, beneficiaries were asked to indicate which 
places they would be liely to go if they had questions. Six-one percent say they 
Six 
would go to their Social Security offces.  percent say they would consult the 
caers. 
Medicare Handbook. and 35 percent would call their 
Medicare Handbook is issued to beneficiaries when they enroll in the program. 
The 
Beneficiares are usually notifed of changes to the program through notices in the 
handbook was mailed to each beneficiary in 1989 after the 
mai. However, a new 
199 after the 
Catastrophic Coverage Act was passed by Congress, and then again in 
Act was repealed. 
thi 
Most beneficiares (90 percent)  the  Medicare Handbook is "general helpful, 
When 
although onl 15 percent say they have used it 3 or more times in the last year. 
asked how they would lie to be notifed of Medicae changes, 61 percent of the 
two 
beneficiaries indicate a preference for notifcation through the mail. Fort-
thi 
percent  Medicare should mai a new handbok each year. 
""A  :1,  :;:--"".;:. :'' :.-
BENCI  GENY SATI wr 
ACRL  .  MEICAR'S 
PROCING OF 
Effective September 1, 199, beneficiaries no longer submit claims. Providers submit 
three percent of the beneficiaries are at least "generally 
clais for them. Ninety-
satisfied" with the way Medicae processes their claims. In 1989, only those 
beneficiares who submitted their own claims were polled, and 88 percent were 
satisfied. 
thi 
Ths year 81 percent  their clais are paid quickly enough, which is signficantly 
when only 74 percent thought so. 
higher than in 1989 
BENEFICIARIES ARE SATISFIED WITH CLAIMS PROCESSING 
100  93% 
Legend 
1989 
1991 
Sa 
Prng  Qu 
wi  Clams Pai  Enough 
CI 
Presg Prble 
three percent of the beneficiaries, in general, were satisfied with 
Although niety-
clai  When gien a list 
processing, many had encountered some diffculties. 
clai 
possible reasons they might be disatisfied with  procssing, two-thids (67 
percent) identied one or more problems they had experienced. 
Th-eight  have had problems 
percent of al beneficiaries say they 
understadig what Medicae paid on their clai and why. 
determg 
Twenty-four percent cited a problem  how much their other 
pay. 
inurance should 
Eighteen percent have had clais denied. 
i ..IJla  Fifteen percent have had diffculty getting information on the status of their
clai. 
Appendix E gives a breakdown of the problems beneficiaries cited, with relationship to
whether they were satisfied or dissatisfied with claims processing. 
Over three-fourths (78 percent) of the beneficiares knew they could appeal decisions 
made on their Medicare claims, but only 30 beneficiaries had ever 
fied an appeal. 
Most of the 30 understood the  appeals (74 percent) and 
fial decisions on their 
thought their appeals had been handled fairly ( 65 percent). 
BENCI 
WI CAR' 
MOS  AR SATIFI  TEHONE 
SEVICE. 
To faciltate their assistance to beneficiaries, Medicae carrers have toll-free 
telephone numbers. The numbers are  Medicare Handbook and on 
included in the 
each notice sent to beneficiaries when a claim has been processed. 
Th-
four percent of the beneficiaries have called their carers to obtain 
inormation-using either the toll-free number or a local number. Eighty-four percent 
of those who have caed say they were satisfied with the servce they received. 
However, 82 percent of the callers cited various 
difculties they have experienced 
when callg carrers. 
Sees 
Prble wi Telphone 
From a  reasons beneficiaries might have been dissatisfied the last time 
lit of possible 
they caed their caers: 
Fif-
three percent (70 percent of those who say they were satisfied) say the 
lie was busy.

Fort-three percent (49 percent of those who say they were satisfied) were put 
on hold" too long. 
aners 
Twenty-fie percent say they received diferent  from diferent people. 
Sixeen percent did not understand the carrers' aner(s). 
Theen 
percent sad the person answerig the call was not very courteous. 
Ten percent were unable to get their questions anered.  Appendix E gives a breakdown of the problems beneficiaries cited, with relationship to 
whether they were satisfied or dissatisfied with carrers' telephone servces. 
AuImtte 
Voice 
Some carrers use an automated voice sytem for 
responding to inquires. Thir-five 
beneficiaries in the survey had experienced these systems. Nineteen of the 
beneficiares, however, said they did not have a touch-tone phone to 
utile the servce 
and 12 reported difculty understanding the directions. 
BENCI  OFF 
SPEC 
FEW  USE  SERVICE  BY MEICAR 
1: 
Seond Opn on th  for Surer 
Less than half (41 percent) of the beneficiaries are aware that Medicare pays for a 
second opinon concerning the need for surgery. 
thi 
Hal of all the beneficiaries 
second opinions should be required for non-
emergency surgery. Most of the others say it should depend on the tye surgery 
recommended. 
Of the beneficiares who have had surgery since being covered by Medicare, only 28 
percent have sought a second opinon. Most got the name of the second physician 
from the physician who recommended the 
surgery. Only two beneficiares had ever 
used Medicare s Second Opinon Referral Center. 
Physicians who agree to charge beneficiaries no more than Medicae s approved 
amount for varous servces are called "participatig physicians." Over three-fourhs 
(76 percent) of the beneficiares are aware that some physicians work under thi 
arangement. Six-one percent of the beneficiaries go to paricipating physicians. 
Twenty-eight percent do not know if any of their physicians are "participating. 
About hal (51 percent) of the beneficiaries know they can get inormation from 
Medicae about parcipatig physician. That response is signcatl higher than the 
43 percent in 1989. However, onl 16 percent of those who know of this servce have 
ever used it. Six-fie percent of al the beneficiares indicate they would be liely to 
contact Medicae about parcipatig physician in the futue.  .. 
. . .. - ' -  ~~~
Rep 
gu 
and Nung Home 
Every year HCF A publishes Medicare beneficiary mortality rates for individual 
is designed to help beneficiaries (and others) make 
hospital. The information 
inormed choices in selecting hospitals. The HCF A also publishes the results of 
nursing home inspections. 
home report than 
Beneficiares are more aware of the nursing  they are of the 
mortalty figures, as the followig chart shows: 
FE AR AWAR OF MEICAR RERTS 
Nurin Home 
Inpeons 
Mortty Rate 
1989  1991  1989  1991 
Respondents Aware Of 
10%  21%  25% 
Inormation 
Those Aware Who Have Used 
10% 
Inormation 
Respondents likely To Use

Inormation In Future 
54%  51%  86%  88%

signifcantly diferent 
In summary, the level of beneficiar satisfaction in 1991 is at least as high as in 1989, 
and is signcantly higher for some aspects of the program. 
::"f .""
,:. - - ,". '., ...
ENDNOTES

1. Offce of Inspector General, United States Deparment of Health and Human 
Beneficiary Satisfaction with Geor  s Medicare Carrer. OEI-049001050. 
Servces. 
Februar 199. 
2. Offce of Inspector General, United States Department of Health and Human 
New Jersey Medicare Beneficiary Satisfaction. OAI-02-900204. October 
Servces. 
199. 
havig 
s failure to cite a problem from the list is interpreted as not 
3. A beneficiar 
experienced that problem. Percentages are calculated.accrdinglY 
interpreted as not havig 
4. A beneficiar s failure to cite a problem from the lit is 
experienced that problem. Percentages are calculated accordingly. 
f"'o  :J:  ~~~~
. ' '''''' ,::"""", ';-
APPENDIX A

SELON 
MEODS AN SAMLE 
The purpse of thi survey was to assess beneficiar experience and satisfaction with 
the Medicae program. The sample unierse was comprised of beneficiares who 
received Par B Medicare benefits in Calendar Year 1989. 
From approxiately 25 miion individuals who received such benefits, a non-stratifed 
simple random sample. was selected. 
Based upon previous exprience with simar client and beneficiar surveys, the sample 
siz was calculated to produce an estimate withi 10 percent of the true value at the 
are 
95 percent confdence level. To  at the sample size, standard equations were 
used for estiating sample size with a binar response variable. 
A sample of 637 Health Insurance Qaim (HIC) numbers was drawn from HCF A' 
Par B Medicae Anual Data System (BMA) fies. Those numbers were cross-
matched with Social Securty s Master Beneficiary Record (MBR) fies to obtain the 
name and address associated with each HIC. 
Six hundred th-seven questionnaires were maied on December 14, 199. It was 
subsequently learned that two beneficiaries were deceased and two were erroneously 
selected. In addition, fie questionnaies were undelierable. Ths reduced the sample 
from 637 to 628. 
A second maig to 247 non-respondents was done on January 8, 1991. Two weeks 
ca 
later, telephone  were made to those for whom numbers could be obtained. 
responses. 
These follow-up effort resulted in the receipt of 163 
Ultiately, beneficiaries retued 519 completed questionnaies. The response rate was 
83 percent. 
r- ""  APPENDIX 
RENSES TO 1991 SURVEY OF MEICAR BENCIY 
SATIFACI0N 
. Not every respondent answered every question. Percentages are based on actual 
responses. The number of respondents not answerig an individual question is not 
roundig. 
included in the caculation of percentages.

. The sum of indivdual percentages may not equal' 100 percent due to independent
. For Questions 2, 9, 11, 13, 19, 22, 24 and 44, respondents could check more than 
one choice. The sum of the percentages wi total more than 100. 
Queson  Respons  Percentage 
MEICA COVEGE 
PART 1: 
tb
1. In genera do 
you 
a. The Medicae program is 
understadable?

395

107

NO ANSWER: 
ca 
b. You  get inormation about 
Medicae when you need it? 
NO ANSWER: 
c. Medicae payment policies

are understandable?

366 
128 
NO ANSWER:  '!;.
Respons  Percenta 
Quesn 
clais 
d. Medicae pays your 
quickl enough?

399 
NO ANSWER: 27 
ty  Medcae? 
2. Wht  of medca inurce do you or your spous have in addition to 
- Number Respondig to Question)
=4fT 
(N 
MEDICAI 
INSURCE RELATED

HEALTH 
155

TO EMPLOYMNT 
INSURCE TO

PRIVATE 
MEDICAR  126

SUPPLEMENT 
CHUS 
OTHR  134 
DO NOT HAVE ADDITIONAL 
INSURCE COVERAGE

NO ANSWER: 22

ar 
in goo heath?

3. Do you feel at th tie you 
325

171

NO ANSWER: 23

ben 
hosita for  you have 
4. Have you ev ben a patient in a  at leat one night since 
cored by Medcae? 
334 
173 
NO (Skip to Q-6) 
NO ANSWER: 12 
in a 
Thinkig about the mos recnt tie you were a patient at leat one night 
5.  Medca pa for? 
hopita wa it clea. to you what 
251 
NO ANSWER: 
,:7  v",  ",?-,". ' " ;,:
Respons  Percnta 
Question 
6. Have you ever recived medca servce in your home from a home heath agency 
core 
Medca? 
since you ha ben  by 
NO (Skip to 0- 424

NO ANSWER: 20

Thin1r about the mos rent tie you recived medca servce in your home from 
7. 
a home heth agency, wa it clea to you what Medca pad for? 
NO ANSWER: 2 
nur  ca 
8. If you should ever nee  home  do you have a way to coer the cot? 
125

NO (Skip to 0-10)  320

CUNTY LNIG IN NUSING 
HOME (Skip to 0-11)

NO ANSWER: 56

li 
9.  below are some ways peple might pay for nuring home ca. Whch of 
would you rely on jf you ever neeed nuring home cae for more  month? 
th 
Resndig 
to Question) 
(N=118 - Number 
PERSONAL SAVIGS 
REMENT 
INCOME 
INSURCE

PRIVATE 
MEDICAI

EOUIT IN YOUR HOME 
OTHR

NO ANSWER: 7

th  ca. 
10. Ma peple  Medcae twhi  pay for long-term nuring home  It cuentl 
Before toW. did you  tht Medca WOUl PAY for long-term
ndoe nou 
  ho ca 
for more  month? 
th 
107

313

NO ANSWER: 

"'l"  ;?f  't ,...  Queson  Respons  Percenta 
PART 2: GHITlN  INRMTION ABUf MEICAR 
11. The followg ar some place peple might go to get aners if they have questions 
about their Medca cora. Would you be liely to go to an of the followg? 
question) 
(N=S09 - Number ResCpondig Lto  S 
INSURCE COMPAN. THT PROCESES, 
YOUR MEDICAHR ABOOK 180 
TH MEDICAR 
RElATI 303 
SECUIT OFFCE 
TH SOCIA  312 
A FRIEND OR  S OFFICE 
YOUR DOcrOR' 198 
INSURCE SALPERSON 
AN  S GROUP
A SENIOR CITEN'
AA 
OR OTHR MEMBERSHIP

GROUP  114

OTHR

NO ANSWER: 

spec 
12 We would lie to ask you about ties when you have neeed to get 
coerae. 
inormtion about your Medcae  How often were you able to get the 
inormtin you neeed?

TH 
MOST OF  228 
TH 

SOME OF 
SELDOM OR NEVER

I HAVE NEVER NEEDED

INORMTION  168

NO ANSWER: 

B - 4
 Queson  Respons  Percenta 
pr 
13. Lite below ar ways the Goernent could us to tell peple about changes in the
Medca  Whch way would you lie to be notied of chages? 
(N=509 - Number Respondig to Question) 
PAMHLTS OR HABOOKS

THOUGH  308

WTHI MA  
NOTICE  SOCIA SECUIT 
CHCK 
211 
ANOUNCEMENT IN 
NEWSPAPER

ANOUNCEMENT ON TELEVISION

AN RAIO

SPEECH OR PREENTATIONS BY

MEDICAR REPREENTATIV

OTHR

NO ANSWER: 

14. Do you th Medca nee to ma a complete, updted Medcae Handbk each 
ye 
to everyone who ha Medcae? 
209

293

NO ANSWER: 

us 
Hadbk? 
15. How ma ties in the  your Medcae 
pat yea have you 
TI 
TI 
OR  298
TH 
MORE  , 54 
I DO NOT RECAL RECEIVG A

MEDICAR HABOOK

(Skip to Q-18)  116

NO ANSWER: 51

th 
Mede Hadbk 
16. Do you  the 
GENERAY HELPFU 
304

GENERAY NOT HELPFU

NO ANSWER: 16

B - 5
 Queson  Respons  Percenta 
Hadbk 
Thinking about the Medcae  you have recived would you say tht...
17. 
a. The wording is eas to 
understad? 
253 
NO ANSWER: 20 
b. The amount of inormation 
covered is sufcient? 
249 
NO ANSWER: 27 
c. The letterig is large 
enough to read? 
315 
NO ANSWER: 
MEICA 
PART 3: 
proc 
Ovra  clai? 
18.  how satified are you with the way Medcae ha  your 
VERY SATISFIED  143 
GENERAY SATISFIED  320 
GENERAY DISSATISFID 
VERY DISSATISFID 
NO ANSWER: 
B - 6
 Question  Respons  Percentage 
ditified 
c19l. Tahe  followg are poible reans why someone might be  with Medcae
Hae an of the followg ben a prblem for 
you? 
(N=349 - Number Respondig to Question) 
GETTG INORMTION ON 
CLAS 
STATUS OF YOUR 
DETERMINING HOW MUCH SHOUL

BE PAI BY OTHR INSURCE

YOU HAVE  123

UONERSTTANINHG WHTR MEDI CAR 
WH 
CLS AN 
PAYS ON YOUR  198 
CLAS
MEDICAR DENYG YOUR 
NO ANSWER: 170 
CAG 
MEICAR 
PART 4: 
pro 
cla? 
20. Have you ever caed the inurce compa tht  your Medcae 
174

NO (Skip to Q-25)  333

NO ANSWER: 

2r1.eTivhin?ki ng about the lat tie you caed how satified were you with the servce you
VERY SATISFIED

GENERAY SATISFIED  102

GENERAY DISSATISFID

VERY DISSATISFID 
NO ANSWER: 2 
B 
 -..
."..". . 
Respons  Percenta 
Question 
2i2n Ucstee  below ar poible reans tht someone would be ditified with cag the
compa. Did you have an of the followg problems the lat tie you 
caed? 
Queson) 
(N=143 - Number Respondig to 
LIN WAS BUSY

PUT ON "HOLD" TOO LONG 
ANSWERS GIVN WERE NOT 
UNERSTANABLE. 
GOT DIFRENT ANSWERS FROM 
DIFRENT PEOPLE 
WAS NOT ABLE TO GET MY 
ANSWERED 
OTHR 
QUETION(s) 
PERSON ANSWERING CAL WAS NOT
VERY COURTEOUS
NO ANSWER: 31 
proc 
inurce compa tht 
Thinking about the la tie you caed the  your 
23. 
cla how wa your ca anered? 
BY A MEDICAR EMPLOYEE

(Skip to Q-25)  115

BY AN AUTOMATED VOICE

NO ANSWER: 24

in 
24. lite below ar poible reans tht someone would be ditified with cag the 
compa and  automated voice. Did you have an of thes problems
gettg an 
th la tie you caed?

(N=32 - Number Respondig to Queson) 
DID NOT HAVE A TOUCH-TONE 
TELEPHONE TO REPOND TO 
AUTOMATED VOICE SYSTEM

COUL NOT UNERSTAN 

DIRCIONS GIVN BY 
AUTOMATED VOICE SYSTEM

OTHR

NO ANSWER: 3

B - 8
 Resns 
Question  Percentae 
APPEAG 
PART  S: 
diee  re 
25. Someties peple  with the decions made on their Medca cla. When 
th happns you may appe or request a  of thos decions Did you know 
before tody tht you Could appe or reuest a revew? 
390

110

NO ANSWER: 

cla 
26 Have you ever appeed a decion made by Medcae on a  you submitted? 
NO (Skip to Q-29)  457

NO ANSWER: 32

cla? 
27. Did you understad the fial decion made on your 
NO ANSWER: 3 
th 
28 Do you  your appe wa handled faly? 
NO ANSWER: 4 
SEND 
GHITlNG  OPINONS 
PART 6: 

Medca wi 
29. If your docr recmmends tht you have surgery,  help you pay to get 
doc  nec.e. 
the opion of another  to mae sur the sugery is  Were you 
bhefoare  tody tht Medca would help to pay for yore u to get a send opinon 
awe 
before  suery? 
207

298

NO ANSWER: 

B - 9
 . - " ,.,. .  , ---- .- - - - ---
Question  Respons  Percentae 
th 
30. Do you  peple should be requied to get a send opinon frm another docor 
su  ecss 
to mae  non-emergency surgery is rea n
255 
DEPENDS ON TH TYE 

SURGERY  234

NO ANSWER: 

31. Have you ever ba sury since you have ben coered by Medcae? 
292

NO (Skip to Q-36)  210

NO ANSWER: 

before tody  the nae of  send docor frm 
tht you could get 
32. Were you awae 
Medca  Send 
Center? 
Opinon Referr 
213

NO ANSWER: 6

send 
33.  Thinking about the lat tie you had surery, did you get a  docor's opinon 
before havig the surery? 
NO (Skip to Q-36)  209

NO ANSWER: 2

34. Where did you get the nae of the send docor you got an opinon from? 
Resndig 
to Queson) 
(N=79 - Number 
TH DOCOR

FROM 
RECOMMNDING SURGERY

FROM ONE OF YOUR OTHR 
DOORS 
RELATI 
FROM A FRIEND OR 
FROM MEDICAR'S SECOND

OPINON REFERR CENTR

OTHR

NO ANSWER: 2

B 
 :.. ,..'.---, ,,, -,,
Respons  Percentae 
Question 
cJa  send 
docr fie a Medcae  for the  docor's opinon? 
35. Did you or your 
DON'T KNOW

NO ANSWER: 0

DORS" PROGRA 
PART 7: "PARTICIATIG 
36 Medca ba "pcipatig docrs who hae agee to chage no more 
Medcae s approed amount. Medcae pays 80% of the approved amount, and you
20 
onl resnsible for payi the deducbble and the  cpoinurcre. og? Before tody.

evr hea about Medcae  "pcipatig docors 
you 
386

121

NO ANSWER: 12

37. Are an of your docors "pcipatig" docrs? 
304 
139

DON'T KNOW 
NO ANSWER: 

38 Were you  before tody tht you could get inormtion on which docors are in 
Medca  "pawac  itig" prog? 
251 
245

NO (Skip to Q-4O) 
NO ANSWER: 23

39. Have yo evr us th inormtion to selec a docr to viit? 
210

NO ANSWER: 2

't 

B 

"-0: T/,  C""  ,.r"0""":. --.
-, . . '" ,"" ?'!:'
Question  Respons  Percentage 
40.  Thinking about the futu, how liely ar you to us the inormtion about 
to selec a docor to viit? 
pacipatig docors 
LIKLY TO USE TH INORMTION 316

NOT LIKLY TO USE 

INORMTION 
169

NO ANSWER: 34

FACI 
HEnI CA. 
PART 8: 
41. For  ar interested the Medcae prog ha inormtion by indidua 
peple who 
hospita on mortty (death) rates of Medcae patients  before tody 
Were you awae 
Federa Goernent publihes "Medcae Hospita Mortty Inormtion?" 
tht the 
NO (Skip to Q-43)

NO ANSWER: 42

us 
42. Have you ever  the "Medcae Hospita Mortty Inormtion" to choo a 
hosita? 
NO ANSWER: 0 
43. If in the futue you nee to be hospitali  how liely are you to us the mortty
(deth rate) inormtion to selec a hospita? (Asume you have a choice of going to one 
of tw hospita and both ar equa convenient and semigl of 
equa quaty. Would 
you us th mortty inormtion to selec which hospita to go to?) 
LIKLY TO USE TH INORMTION 236

NOT LIKLY TO USE 

INORMTION 
228

NO ANSWER: 55

B 

't'  ,j.t  ---..- -
Question  Respons  Percenta 
44. Who seleced your hospita the la tie you were hospitali7.e 
(N=48 - Number Respondi to Question) 
YOU  175 
YOUR DOcrOR  280 
YOUR RELATI OR FRIENDS 
OTHR 
HAVE NEVER BEEN IN HOSPITAL. 
NO ANSWER: 32 
45. The Medcae prog aJ publihes inormtion on the results of inpeons done 
on nurg  Before tody. were you awa tht the Federa Goernent had 
ty  homes 
of inormtion on 
nurin homes? 
120 
NO (Skip to Q-47)  370 
NO ANSWER: 29 
us th 
46 Have you ever  inormtion to choo a nuring home? 
106 
NO ANSWER: 2 
47. Now tht you know about the nuring home inormation, ar you liely to us the
inormtion if you should nee to selec a nuring home? 
LILY TO USE TH INORMTION 416 
NOT LIKLY TO USE 
INORMTION 
NO ANSWER: 45 
an 
Is there  els you wat to teD us about Medca? 
POSIT

NEGATI
MID 
OTHR 
NO ANSWER: 369 
B - 13
 APPENDIX C

TI 
COMPARN TO  198 SURVEY 
SIM BET 
TI SUVEYS

The majority of the questions from the 1989 Medicare Beneficiary Survey (OAI-0489
8900) were used in the 1991 survey. Twenty-eight questions from the earlier survey 
were essential duplicated in the current surey. 
In the current survey those questions 
were numbered 1, 3- , 12, 25, 29, 31, and 33-47. 
Eight additional questions were similar to previously asked questions. But for 1991, the 
scope of those questions, or the segment of beneficiaries to whom they were addressed, 
were appropriately updated. 
Medicare Handbook. 
In 1989,

Questions 16 and 17 ask specifcally about the 
beneficiaries were asked about all Medicare inormational material.

Questions 18 and 19 about claim procssing were asked of all beneficiaries. In 1989, 
only those beneficiaries who submit their own claims were asked. (providers submit 
al 
clai now. 
Questions 20-22 ask beneficiaries about their experiences calling their carrers using 
either a loca number or the toll-free number. In 1989, they were asked only about 
the toll-free number. 
Medicae Second Opinon Referral Center was asked of only 
Q1Jestion 32 about the 
those beneficiaries who had had surgery since being covered by Medicae. In 1989, 
all beneficiares were asked. 
DIFCE BET TI 
SUVE 
n. 
The current surey used a questionnaie of larger prit, for easier reading by 
beneficiaries. There were alo fewer questions, 47 compared to 54 in 1989. 
(Contnbuting toward a reduction in the number of questions was the repeal of the 
Catatrophic Health Cae provions. 
The wording and/or format of some questions were changed. In 1989, the questionnaie 
priar. 
contaed a YE or NO format  In 1991, beneficiares were asked to "CHCK 
AL THT APPLY." That is, intead of circlig ''Y'' or "  NO" checked the 
, they 
applicable responses. Alo, for the current survey some 
C  - -
questions were designed to offer a greater number 
of optional responses. For example,
cag 
Question 22, on possible problems related to  a carrer for information, contained 
seven options; previously there were six. 
Resns 
Rates 
In 1989, there were 401 respondents, and in 1991, there were 519. Thus, the response

rate for the 1991 surey was 18 percent higher than the previous rate (83 percent vs. 

percent).

DIFCE BET 
FIINGS OF SIGNICAN  11 1WO
SUVES 
Where suffcient simarities existed between questions in the two surveys, responses were
compared to determe if differences were statistically signcant. For purposes of this
survey, "signcant" diferences refer to those which were determed, using the t-test, to
be substantial. The purpose was to determe whether the two surveys reflect signcant
diferences regardig beneficiaries' experience and satisfaction. 
The followig discusses !m those questions for which responses were signcantly
diferent. 
Prog 
More Beneficies Understad The Medca 
thi 
In the 1991 survey, 79 percent of the beneficiaries  the Medicare program is
understadable; seventy-three percent thought it was understandable in 
1989. 
Cl 
Th 
Ar 
More Beneficies  Paid QuckJ Enough 
Eighty-one petrhcen t and seventy-four percent of the beneficiaries in 1991 and 1989 
clai 
respectively,  their  are paid quickly enough. 
Mor Beneficies Undersd 
Hospita Payments 
In 1991, 79 percent of the beneficiaries who had been 
hospitalied understood what
Medicae paid, compared to 67 percent in 
1989. 
Benefies Ca 
More  Get Inormtion When Neeed 
In the 1991 surey, 90 percent of the beneficiares  ca 
get inormation about
say they 
Medicae when they need it. In 1989, 85 percent thought they could get such
inormation. 
c- 2
 ... - -.. ...- - " ::
Fort-five percent of the beneficiaries in the 1991 survey could get specific
tie
inormation about their coverage  most of the  . In 1989, fewer beneficiaries (37
percent) were able to get information most of the time. 
Prog 
More Beneficies Ar Awae of the "Parcipatig Physician  but Fewer Use 
or Ar Liely to Use the Inormation to Selec a Phyici 
Beneficiares were much more aware of the "participating doctors" program than in 
1989 (51 percent in 1991, and 43 percent in 1989). 
However, in  the information about the program to select
1991, fewer beneficiaries 
a docor (9 percent compared to 14 percent in 
1989). Also, currently fewer 
likely to use the information (51 percent compared to 68
beneficiaries said they were 
percent). 
Fewer Beneficies Are  FamiJar With The Medcae Hospita Mortty Inormtion. 
Beneficiaries in the 1991 survey were less famiar with the hospital mortality
inormation than those in the 
1989 survey--7 percent in 1991 vs. 10 percent in 1989. 
c- 3
 " "
APPENDIX D

ANALYSIS OF REPONDEN VS. NON-REPONDEN 
A consideration in surveys of this tye is that the results may be biased if the non-
respondents are signcantly diferent from the respondents. To determe 
whether
signcant 
diferences exist in this survey, varous analyses were performed, including a
comparison of the age and gender of the 519 respondents and the 
109 non-respondents. 
The analysis revealed no indication of biased survey 
results. 
ANALYSIS BY AGE 
The average age for respondents was 73
, compared to age 74 for non-respondents.
signcat 
There being no  diference between the average ages for the two groups, it was
unnecessar to further analyze this area. 
ANALYSIS BY GENER 
The analis by sex showed that 41 percent of the sample population were males and 59 
percent were females. Ths distnbution very closely approximates the distnbution of
males and females in the overall Medicare 
beneficiar population. 
The ditnbution of males and females responding (41 percent/59 percent) was
comparable to the distnbution of non-respondents (39 
percent/61 percent). 
Eighty-three percent of the men in the sample responded, and 82 percent of the women 
responded. 
The representativeness of the sample and comparable response rates for males and 
females suggests the absence of bias. 
TI 
RENSE 
ANALYSIS BY  OF 
As an additional guard agaist biased results some surveys simar to thi one 
reviewed for diferences which may 
exit between early and late responses. The- rationale
is that late respondents and non-respondents 
may share certai tendencies. For exaple,
when compared to early respondents, late respondents and non-respondents could hold 
more negatie (or, at least, less enthusiastic) opinons. 
D  -_.
 . .
. , ~~~ ""'''' "",'''.-........ ... - , .- --., ---. :;
To test for possible non-response bias in this 
survey, the fist 403 responses (78 percent)
were compared to the last 
116. 
Thee key questions on the questionnaire (Questions 1a, 1b, and 1d) were used for that 
analysis. The three questions, posed to all respondents, relate to program 
understadabilty, inormational servces, and claim processing. 
The early responses to the key questions were
, cumulatively, 84 percent positive. The
later responses were 81 percent positive. 
Ths diference of three percentage points is
not statisticall signcant. 
D- 2

.o.  :t::\..  I"",  ,. . 
, ' ""I:DA  -h-"''' ",--- --- .''."-'':r'''  ,"''  ..-..'  , . .-- .,  "':';.
APPENDIX E 
CL 
PROBlE WI TEHONE SERVICE AN  PROCING 
Ths appendix presents a breakout of beneficiares' responses regarding problems they 
have exprienced. Prom a list of possible reasons they might have been dissatisfied the 
last time they called their carrers, beneficiaries cited problems they experienced. In a 
simar manner they cited reasons for dissatisfaction with claims processing. 
CAG 
SOME HAVE PROBLE 
Caed  Cited  Generall  Very 
Carrer  Problems  Satisfied3  Distisfied4  Distisfied5 
N = 174  N = 143  N = 144  N = 19  N = 9 
Problems Usted  Freq. / %6  Freq. / %  Freq. / %  Freq. / %  Freq. / % 
lie Bus  92 /53%  92 /64%  78/ 54%  9 / 47%  5 / 56% 
On Hold  Too Long  74 / 43%  74/ 52%  55 / 38%  15 / 79%  4 / 44% 
Recived Confctg Aners  43 /25%  43 /30%  26 /18%  8 / 42%  9 /100% 
Aners Not Understoo  27 /16%  27 /19%  19 /13%  5 /26%  3 / 33% 
Not Very Couneous  22 /13%  22 /15%  10 / 7%  6 /32%  5 / 56% 
Inquir Not Anered  18 /10%  18 /13%  10 /7%  3 /16%  5 / 56% 
Wl 
SOME HAVE PROBLE 
Cited  Generally  Very 
Beneficiares  problems  Satified3  Distisfied4  Distisfied5 
N=463 
N = 519  N = 349  N = 25  N = 12 
Problems Usted  Freq. / %6  Freq. / %  Freq. / %  Freq. / %  Freq. / % 
Understading Medica

Payments & Why  198 / 38%  198 / 57%  168 / 36%  17 / 47%  7 / 58%

Determing Amount Other

Inurnce Should Pay  123 / 24%  123 / 35%  106 / 23%  12 / 48%  3 /25%

Cl 
Had  Denied  95 /18%  95 /27%  74 /16%  11/ 44%  9 /75% 
Clim  80 /15%  80 /23%  64 /14%  6 /24%  6/50% 
Getting Statu of 
caers. 
Number of beneficies who had called their 
Number of beneficiries who cited one or more problems. 
genera 
Numbe of beneficiries who said they were "very or W satisfied 
Number of beneficies who' sad they were Wgenera ditified 
ditified 
Number of beDefici  . w)lo said they were "very 
6percDtage of the population if a beneficirys faiure to cite the problem lite is interpreted as not having exrience the 
problem. 
E