Department  of Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENEML 
MEDICARE  BENEFICIARY  SATISFACTION: 
1993 
AUGUST  1993  OFFICE OF INSPECr.OR GENERAL 
The mission of the Office of Inspector General (OIG),  as mandated by Public Law 95-452, as 
amended, is to protect the integrity of the Department  of Health  and Human Services (HHS) 
programs as well as the health and welfare of beneficiaries served by those programs.  This 
statutory mission is carried out through a nationwide network of audits, investigations,  and 
inspections  conducted by three OIG operating components:  the Office of Audit Services, the 
Offke  of Investigations,  and the Office of Evaluation and Inspections.  The OIG also informs 
the Secretary of HHS of program and management problems and recommends courses to 
correct them. 
OFFICE OF AUDIT  SERVICES 
The OIGS  Office of Audit Services (OAS)  provides all auditing services for HHS, either by 
conducting audits with its own audit resources or by overseeing  audit work done by others. 
Audits examine the performance of HHS programs and/or its grantees and contractors in 
carrying out their respective responsibilities and are intended to provide independent 
assessments of HHS programs and operations in order to reduce waste, abuse, and 
mismanagement and to promote economy and efficiency throughout the Department. 
OFFICE OF INVESTIGATIONS 
The OIGS  Office of Investigations  (01)  conducts criminal, civil, and administrative 
investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries  and of 
unjust enrichment by providers.  The investigative efforts of 01  lead to criminal convictions, 
administrative sanctions, or civil money penalties.  The 01  also oversees State Medicaid fraud 
control units which investigate and prosecute fraud and patient abuse in the Medicaid program. 
OFFICE OF EVALUATION  AND  INSPECTIONS 
The OIGS  Office of Evaluation and Inspections  (OEI)  conducts short-term management and

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

the Congress, and the public.  The findings and recommendations  contained  in these inspection

reports generate rapid, accurate, and up-todate  information 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,

Office of Evaluations and Inspections.  Principal OEI staff included:

Atlanta Retion  Headquarters

Betty Apt, Team Leader  Tom Noplock

Kimberly Graves, Cmztrac@- Wm. Mark Krushat, SC.D.

Josiah Townsel  Barbara Tedesco

Peggy Daniel  Tina Fuchs

Paulette Monroe

Jacqueline Andrews

To obtain a copy of this report, call the Atlanta Regional  Office at (404) 331-5022.
 Department  of Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENEML 
MEDICARE  BENEFICIARY  SATISFACTION: 
1993 
AUGUST  1993  OEI-04-92-004S0  EXECUTIVE  SUMMARY

PURPOSE 
To  determine  Medicare  beneficia~  experience  and  satisfaction  with  Medicare  services 
in  1993. 
BACKGROUND 
The  Office  of Inspector  General  (OIG),  Department  of Health  and  Human  Services 
(HHS),  surveyed  a random  sample  of Medicare  beneficiaries.  We mailed  a 
questionnaire  to  1293 randomly  selected  beneficiaries  for whom  Medicare  Part  B 
claims were  submitted  in Calendar  Year  1991.  Participation  in the  survey was 
voluntary  and  yelded a response  rate  of 84 percent. 
We  attempted  to compare  the  level  of beneficiary  satisfaction  in 1993 to that 
expressed  by beneficiaries  in 1989 and  1991.  However,  a comparison  was not  always 
possible  because  of differences  in survey questions  for the  three  survey years.  In 
instances  where  our  survey questions  were  the  same,  we did compare  beneficiary 
satisfaction  and  experience. 
FINDINGS 
Ove@  most  beneficiaries  expressed  satisfaction  with the  Medicare  program. 
We  draw  this conclusion  from  the  following findings: 
Most benejkiaries  said the pmgmm  was undemtandhble and they were ablk ti  get general 
Medicare  bafonnation when they needed k 
. Seventy-five  percent  of the  beneficiaries  said they  think  the  Medicare  program 
is understandable.  This  number  is comparable  to the  number  of beneficiaries 
who expressed  understanding  in 1989 and  1991 when  73 and  79 percent, 
respectively,  said the  program  was understandable. 
. Seventy-two  percent  of the  beneficiaries  said they  could  get  information  about 
Medicare  when  they needed  it.  Only seven  percent  said they  could  not  get 
information  when  they  needed  it.  Twenty-one  percent  said they  did not  know if 
they  could  get  information. 
Most beneji&ti  expressed sati$action  ~  allhough some  lacked  understanding oj 
chins  processing. 
. Eighty-three  percent  of Medicare  beneficiaries  said they were  at least  generally 
satisfied  with the  way Medicare  processed  their  claims. 
i  . Thirty-five  percent  of all the  beneficiaries  had  experienced  a problem  with their 
last  claim.  However,  this insignificantly  less than  the67percent  who  cited 
problems  in 1991. 
. In the  1991 and  1993sumeys,  themost  frequently  cited  problem  tith  claims 
processing  was understanding  what  Medicare  paid  for and  why. 
Mxt  benejiihries  who cakd  their caniins were sa&jied  wikhserviag  but some  tek@orae 
probkms 
W=  encountered 
. Seventy-four  percent  of the  beneficiaries  who had  called  their  carriers  were  at 
least  generally  satisfied  with the  semice  they  received. 
. Half  of the  288 beneficiaries  who called  had  experienced  problems  the  last time 
they  tried  calling.  This is significantly  less than  the  82 percent  who  said they 
had  problems  calling their  carriers  in 1991. 
. In the  1991 and  1993 surveys, the  most  frequently  cited  problem  with  calling 
carriers  was finding  the  line busy. 
Some benejkiati  are aware that Medicare pays for second opinions prior to wugery, but 
f~  obtain them 
. Thirty-nine  percent  of the  beneficiaries  said they were  aware  that  Medicare 
pays for second  opinions  prior  to surge~.  While  this is fewer  than  the  43 
percent  and  41 percent  who were  aware  of second  opinions  in  1989 and  1991, 
respectively,  the  result  is not  statistically  significant. 
. Only  19 percent  of the  beneficiaries  surveyed  in 1993 who had  non-emergency 
surgery  obtained  a second  opinion. 
Mi.w ben@iar&  are aware of participating physichq  and the majority use them. 
. Eighty-three  percent  of the  beneficiaries  said they were  aware  of Medicares 
participating  physicians.  This is more  than  the  77 percent  and  76 percent  who 
were  aware  of participating  physicians  in 1989 and  1991 respectively. 
	 In the  1993 survey, 65 percent  of the  beneficiaries  said they  used  participating 
physicians.  This  use is about  the  same  as in 1989 and  1991. 
ii  TABLE  OF  CONTENTS 
PAGE 
EXECUTIVE  suMMARY 
INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1(cid:1)
FINDINGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4

Beneficiaries  Understand  the  Medicare  Program  . . . . . . . . . . . . . . . . . . . . . . . .  4(cid:1)
Beneficiaries  Can  Get  Information  When  Needed  . . . . . . . . . . . . . . . . . . . . . . . 5(cid:1)
Getting  General  Information..  . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...5(cid:1)
Using Medicare Handbook  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...5

Getting  Specific  Information  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...6(cid:1)
Beneficiaries  Satisfied  With  Medicares  Claims  Processing  . . . . . . . . . . . . . . . . . 7(cid:1)
Claims  Processing  Problems  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...8(cid:1)
Appeals  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...9(cid:1)
Beneficiaries  Satisfied  With  Carriers  Telephone  Services  . . . . . . . . . . . . . . . .  10(cid:1)
Problems  With  Telephone  Services  . . . . . . . . . . . . . . . . . . . . . . . . . ..11(cid:1)
Automated  Voice  System  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...13(cid:1)
Beneficiaries  Use  ofSpecial  Services  . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...14(cid:1)
Second  Opinion  onthe  Need  for Surgery  . . . . . . . . . . . . . . . . . . . . ...14(cid:1)
ParticipatingP hysicianProgram  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  15(cid:1)
CONCLUSION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...15(cid:1)
APPENDICES 
Responses  to1989  and  1991 Surveyof 
Medicare  Beneficiary  Satisfaction  . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-1(cid:1)
Comparison  to the1989and  1991 Surveys  . . . . . . . . . . . . . . . . . . . . . . . . . .  B-1(cid:1)
Analysis  of Respondents  vs. Non-Respondents  . . . . . . . . . . . . . . . . . . . . . . .  C-1(cid:1) INTRODUCTION 
PURPOSE 
To determine  Medicare  beneficiary  experience  and  satisfaction  with Medicare  sewices 
in 1993. 
BACKGROUND 
Me&are  l%gram 
Medicare  is a Federal  health  insurance  program  for individuals  age  65 and  older,  and 
forcertain  categories  ofdisabled  people.  Authorized  in1965by  title  XVIII  of the 
Social  Security  Act, Medicare  serves  approximately  35 million  people,  known  as 
beneficiaries.  In Fiscal  Year  1992, Medicare  paid  benefits  totalling  approximately 
$129 billion. 
The  Medicare  program  has two parts.  Part  A(hospital  insurance)  helps  pay for 
inpatient  hospital  care,  some  inpatient  care  in a skilled  nursing  facility, skilled  home 
health  care,  and  hospice  care.  A person  entitled  to Medicare  automatically  receives 
this coverage.  Part  B (medical  insurance)  covers  physician  services,  outpatient  hospital 
services,  and  other  medical  services  and  supplies.  Part  B is optional.  Beneficiaries 
desiring  this coverage  pay a monthly  premium.  Both  Part  A and  Part  B have 
deductible  and  coinsurance  requirements.  Beneficiaries  must  pay these  either  out  of 
pocket  or through  supplemental  insurance  coverage. 
The  Health  Care  Financing  Administration  (HCFA)  within  the  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  premiums  for 
Part  B coverage.  Private  health  insurance  companies  contract  with  the  Federal 
Government  to service  claims  for Medicare  payment.  Insurance  companies  that 
handle  Part  A claims  are  called  intermediaries.  Those  handling  Part  B claims  are 
called  carriers. 
Recent  Changes 
The  Medicare  program  is continually  undergoing  change.  The  1989 Omnibus  Budget 
Reconciliation  Act  added  Section  1848 to title  XVIII  of the  Social  Security  Act.  This 
new section  required  that,  effective  September  1, 1990, physicians  and  other  providers 
submit  all claims  rather  than  beneficiaries  submitting  their  own.  Effective  January  1, 
1991, it also limited  the  amount  physicians  can  charge  Medicare  beneficiaries.  In  1989, reconducted  anational  sumeyof  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-04-89-
89040).  As a result  of that  study, HCFA  requested  that  we conduct  similar  surveys of 
beneficiaries  in Georgial  and  New Jerse~  -- States  where  there  had  been  reports  of 
beneficiary  dissatisfaction  with Part  B carriers.  As a follow-up  to the  1989 survey, we 
conducted  a second  national  survey of Medicare  beneficiaries  in  1991.  That  study was 
entitled  Medicare  Beneficiary  Satisfaction:  1991.  (OEI-04-90-89030). 
METHODS 
1993 Sunq$ 
In February  1993, we mailed  a survey instrument  composed  of 51 questions  to  1293 
randomly  selected  Medicare  beneficiaries.  We selected  beneficiaries  for whom 
Medicare  Part  B claims  had  been  filed in Calendar  Year  1991. 
Based  upon  previous  experience  with similar  client  and  beneficiary  surveys,  the  sample 
size 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. 
Thirty-seven  beneficiaries  were  dropped  from  the  sample  for various  reasons:  21 
questionnaires  were  undeliverable,  7 beneficiaries  were  deceased,  and  9 individuals 
were  erroneously  selected.  This reduced  the  sample  size from  1293 to  1257. 
Beneficiaries  participation  in the  survey was voluntary.  A total  of  1053 beneficiaries 
returned  completed  questionnaires,  for a response  rate  of 84 percent.  Given  the  size 
of our  sample  and  response  rates,  results  of our  survey are  protectable  to the  universe 
of 35 million  Medicare  beneficiaries.  Percentages  in the  report  are  based  on the 
number  of respondents  answering  each  question  except  in two instances  noted  in the 
report. 
I	 Office of InspeetorGeneral,United StatesDepartmentof Health and Human Services. 
Beneficial  Satisfaction with Georgias Medicare Carrier.  OEI-O4-9O-O1O5O. 
2	 Officeof Inspector General, United States Department of Health and Human Service& ~ 
Jersev Medicare Beneficiary Satisfaction.  OAI-02-90-02040. 
2  C-om*n  to 1989 and 1991 Surveys 
The  majority  of the  questions  in this survey were  also used  in the  1989 and  1991 OIG 
surveys.  However,  in some  instances  we worded  and  sequenced  the  questions  slightly 
different.  In addition,  we provided  more  possible  responses  to some  questions  in the 
1993 survey than  we had  provided  in the  earlier  surveys.  This  made  it impossible  to 
directly  compare  responses  for these  questions  in the  three  years.  However,  we did 
make  comparisons  among  the  three  years  whenever  possible.  We  determined 
significant differences  through  use  of a t-test. 
Appendix  A shows responses  to all questions  in this survey.  Appendix  B provides  a 
general  comparison  of the  1993 survey instrument  to our  1989 and  1991 survey 
instruments.  Appendix  C presents  an analysis  of respondents  and  non-respondents. 
We  conducted  this inspection  in accordance  with the  Quali~  Standards for Inspections 
issued  by the  Presidents  Council  on Integrity  and  Efficiency. 
3(cid:1) FINDINGS
Overall,  most  beneficiaries  expressed  satisfaction  with the  Medicare  program.  They 
said the  program  was understandable  and  they were  able  to get  general  Medicare 
information  when  they  needed  it.  Most  were  also satisfied  with  claims  processing  and 
said  their  claims were  paid  quickly enough.  However,  some  beneficiaries  had 
problems  understanding  exactly what  Medicare  pays for.  They  did not  understand 
Medicares  Explanation  of Benefits.  Most  beneficiaries  who had  called  their  carriers 
were  satisfied  with  services  received.  Although,  some  beneficiaries  found  telephone 
lines busy when  they  called  their  carriers.  -
Approximately  67 percent  of the  beneficiaries  responding  considered  themselves  to be 
in good  health.  Eighty  percent  said  they have  medical  coverage  in addition  to 
Medicare. 
MOST  BENEFICIARIES  UNDERSTAND  THE  MEDICARE  PROGRAM 
Three-fourths  of the  beneficiaries  said the  Medicare  program  is understandable. 
Figure  1 shows that  a 75 percent  level  of understanding  in  1993 is comparable  to the 
levels  expressed  by Medicare  beneficiaries  in 1989 and  1991. 
FIGURE  1 
BENEFICIARIES  UNDERSTAND  PROGRAM 
Pmtaga 
79 
75 
73 
I&l  1!iw  Ifis 
4
 Of the  beneficiaries  who had  been  hospitalized,  61 percent  said they  understood  what 
services  Medicare  paid  for.  Twenty-two  percent  said it had  not  been  clear.  The 
remaining  17 percent  either  did not  remember  or Medicare  had  not  yet paid  their 
bills. 
Most  of the  beneficiaries  (68 percent)  who received  home  health  services  said they 
understood  what  services  Medicare  paid  for. 
We asked  all the  beneficiaries  surveyed  if they  understood  what  Medicare  would  pay 
for on a doctors  office visit.  Fifty-seven  percent  of the  985 beneficiaries  who  had 
gone  to a doctor  since  they have  had  Medicare  said they  understood  what  Medicare 
would  pay for.  Thirty-five  percent  said they  did not  understand,  and  the  remaining 
eight  percent  did not  remember  whether  or not  they  had  a clear  understanding  of 
what  Medicare  would  pay for. 
Medicare  can  limit how much  doctors  charge  beneficiaries  for specific  services.  Sixty-
four  percent  of all the  beneficiaries  surveyed  said that  they were  aware  of this 
limitation.  The  remaining  36 percent  were  not  aware  of this. 
BENEFICIARIES  CAN  GET  INFORMATION  WHEN  NEEDED 
Getting General Information 
Seventy-two  percent  of the  beneficiaries  said they  thought  they  could  get general 
information  about  Medicare  when  they needed  it.  Table  1 illustrates  this is a decrease 
from  previous  years.  However,  the  1993 survey had  a Dont Know response  option 
that  was not  offered  in the  previous  surveys. 
TABLE  1 
CAN  GET  GENERAL  INFORMATION 
Yes  85 %  90 %  72 % 
No  1570  10 %  7%

I I  I

Dont  Know  21 % 
Using the M&are  Handbook 
Over  half  of the  beneficiaries  said they refer  to the Medicare Handbook  for Medicare 
information,  From  a list of possible  places  people  might  go to get  answers  if they 
5(cid:1) have  questions  about  what  Medicare  pays for, beneficiaries  were  asked  to indicate 
which  places  they would  go.  They  could  check  more  than  one  likely source.  Fifty-four 
percent  of all beneficiaries  said they would  refer  to the Medicare Handbook.  Forty-
eight  percent  said they would  go to their  doctors  office.  Forty-five  percent  said they 
would  go to the  Social  Security  Office. 
Although  54 percent  of all beneficiaries  said they would  refer  to the Medicare 
Handbook  when  they  needed  information,  only 42 percent  said they  had  actually  used 
it.  Ninety-three  percent  of those  who had  used  it found  the  handbook  either  very 
helpful  or generally  helpful.  Most  said the  handbook  is easy to understand,  contains 
adequate  information,  and  the  print  is easy to read. 
Twenty-four  percent  of all beneficiaries  surveyed  either  did not  know what  the 
Medicare Handbook  is or did not  recall  receiving  one.  The  Medicare Handbook  is 
issued  to beneficiaries  when  they  enroll  in the  Medicare  program.  Beneficiaries  are 
usually  notified  of changes  to the  Medicare  program  through  notices  in the  mail. 
However,  HCFA  mailed  new handbooks  to each  beneficiary  in  1989 after  the 
Catastrophic  Coverage  Act was passed  by Congress,  and  then  again  in  1990 after  the 
Act was repealed. 
When  asked  how they would  like to be  notified  of changes  in the  Medicare  Program, 
more  beneficiaries  (38 percent)  said they preferred  to receive  a new Medicare 
Handbook  rather  than  any other  type  of notification.  However,  almost  as many  (35 
percent)  said they  preferred  that  a pamphlet  describing  the  changes  be  mailed  to 
them. 
Getting Specific Information 
Sixty percent  of those  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  this number  had  decreased  since  our  1991 survey. 
TABLE  2 
CAN  GET  SPECIFIC  INFORMATION 
I 
I Most  of the  Time  58 %  I  67 %  I 60 %  I 
]Some of the Time  I  29 %  I  23%  [  28%  I 
] Seldom  or Never  I  13 %  ]  10%  (  12%  ( 
6
 BENEFICIARIES  WERE  GENERALLY  SATISFIED  VllTEI MEDICARES 
PROCESSING  OF  CLAIMS 
Eighty-three  percent  of the  beneficiaries  said they  are  at least  generally  satisfied  with 
the way Medicare  processed  their  claims.  (See  Figure  2.)  Likewise,  86 percent  said 
Medicare  paid  their  claims  quickly enough. 
FIGURE  2 
SATISFACTION  WITH CLAIMS  PROCESSING 
very 3atisfied(37%) 
GenerallySatkifM  (4%) 
(6%) 
1 %) 
(3%) 
Figure  3 shows that  the  number  of beneficiaries  expressing  satisfaction  has  declined, 
but  the  1.993 survey had  a response  option  that  was not  offered  in the  1989 and  1991 
surveys. 
FIGURE  3 
LEVEL OF SATISFACTION  WITH CLAIMS  PROCESSING 
100, 
-2% 
E Neither or Unpdd 
Clalm 
&  1991 
1 1$93 
7
 Clabns hc&g  I%blems 
Although  83 percent  of the  beneficiaries  said they were  generally  satisfied  or better 
with the  way Medicare  processed  their  claims,  some  had  encountered  difficulties. 
When  given a list of possible  reasons  beneficiaries  might  be  dissatisfied,  35 percent  of 
the  beneficiaries  surveyed  identified  one  or more  problems  with their  last  Medicare 
claim.  This  is significantly  less than  the  67 percent  who  cited  one  or more  problems  in 
1991. 
Figure  4 shows that  the  number  of beneficiaries  experiencing  problems3  has 
decreased,  but  some  beneficiaries  still have  difficulty understanding  Medicare 
payments. 
FIGURE  4 
CIAIMS  PROCESSING  PROBLEMS 
I 
I I 
an

20 
10

0

Thirteen  percent  of the  beneficiaries  surveyed  said they  did not  understand  the 
Explanation  of Medicare  Benefits  Medicare  sent  after  processing  their 
claims.4 
Nine  percent  said Medicare  took  too  long to pay their  claims: 
3
 NumbersshowninFigure4 representthepercent of all beneficiaries surveyed rather than the 
percent who responded to the question about claims processing problems. 
4	 This  questionwas added for the 1993 suxvey. Therefore, we were unable to compare it to the 
1989 and 1991 surveys. 
5	 This question was added for the 1993 survey. Therefore, we were unable to compare it to the 
1989 and 1991 surveys. 
8  At least  10percent  of beneficiaries  whosaid  theywere  generally  satisfied  or better 
with  the way Medicare  processed  their  claims  also said they  had  a problem  with  their 
last  claim.  However,  Table  3 illustrates  that  the  majority  of beneficiaries  who had 
problems  still expressed  overall  satisfaction  with claims  processing.  To illustrate,  of 
the  72 beneficiaries  who cited  a problem  with having  claims  denied,  71 percent  were 
very or generally  satisfied. 
TABLE  3 
PROBLEMS  WITH  CLAIMS  PROCESSING 
RELATED  TO  BENEFICIARYS  LEVEL  OF  SATISFACTION 
lNumber  of beneficiaries  who cited  a particular  problem  and  a level  of satisfaction. 
I 
Uiz&mWdhg  and  Use of Appeal  Righls 
Medicare  beneficiaries  have  a right  to appeal  or request  a review  of any decision 
made  on their  Medicare  claims. 
Seventy-five  percent  of the  beneficiaries  we surveyed  knew  they  could  appeal  or 
request  a review  of their  claims.  This  number  is slightly lower  than  in  1991 when  78 
percent  knew  of their  appeal  rights. 
9
 Asin  1991, 0nly  sixpercent  (60)  of the  beneficiaries  in the  1993 survey had  ever 
appealed  a decision.  Of these,  67 percent  in 1993 said they  understood  the  final 
decision  made  on their  claims,  and  59 percent  thought  their  appeals  were  handled 
fairly. 
MOST  BENEFICLMUES  WERE  SATISFIED  WITH  CARRIERS  TELEPHONE 
SERVICES 
The Medicare Handbook  and  the  Explanation  of Medicare  Benefits  notice  include 
toll-free  telephone  numbers  of Medicare  carriers  for beneficiaries  who may have 
questions  about  their  claims. 
Only 29 percent  of the  beneficiaries  had  tried  to call their  carriers.  Figure  5 shows 
that  74 percent  of the  beneficiaries  who had  called  said they were  generally  or very 
satisfied  with the  service  they received. 
FIGURE  5 
SATISFACTION  WITH PHONE  SERVICE 
ISFIED (31 %) 
GENERALLY 
SATISFIED 
VERY DISSATISFIED (5 %)
(43 %) 
NERALLYDISSATISFIED(9 %) 
NEITHER (12 %) 
Figure  6 shows a comparison  of 1993 satisfaction  levels with those  of 1989 and  1991. 
Although  fewer  beneficiaries  expressed  satisfaction  in 1993, the  1993 survey  offered  a 
Neither  Satisfied  nor  Dissatisfied  option  that  was not  offered  in the  previous  surveys. 
10(cid:1) FIGURE  6 
LEVEL OF SATISFACTION WHEN CALLING CARRIERS 
 
vh#&mltY 
 
V=m 

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Ndthef 
1$$1 
16$9  1$s 
l%blems  with Telephone Services 
The  29 percent  of the  beneficiaries  (288) who had  called  their  carriers  were  given a 
list of possible  reasons  why they might  have  been  dissatisfied  the  last  time  they  called. 
Half  of them  cited  one  or more  problems.  In  1991, 82 percent  of the  beneficiaries 
who had  called  their  carriers  cited  one  or more  problems. 
Figure  7 illustrates  that  while  the  number  of beneficiaries  who have  problems  calling 
carriers  has  declined,  some  beneficiaries  still find the  lines busy when  they  try to call. 
The  numbers  shown  in Figure  7 represent  the  percent  of all beneficiaries  surveyed 
rather  than  the  percent  who responded  to the  question  about  problems  calling 
carriers. 
11(cid:1) FIGURE  7 
PROBLEMS WITH TELEPHONE SERVICES 
1989 
1991

1993

DmmntAnswer$8nd~  utwuwmdwere ti-illlw.

Of the  74 percent  of the  beneficiaries  who had  called  their  carriers  and were  either(cid:1)
very or generally  satisfied,  at least  30 percent  cited  a problem  the  last time  they  called.(cid:1)
Table  4 on the  next  page  relates  the  level  of beneficiary  satisfaction  to the(cid:1)
beneficiaries  who identified  a problem  calling their  carriers.(cid:1)
12(cid:1) TABLE  4 
PROBLEMS  CALLING  CARRIERS  RELATED  TO 
BENEFICIARYS  LEVEL  OF  SATXSFACTION 
Line  Busy  95  66 %  15 %  19 % 
I  I  I 
On Hold  Too  Long  63  57 %  19 %  24 % 
1  1  I 
Received  Conflicting  38  I  40 %  I 20 %  I 40 %  I
I 
I Answers  I  I  I  I I 
I  i  I  I 
Answers  Not  Understood  22  41 %  36 %  23 % 
I  I  I  I 
Not  Very  Courteous  23  39 %  22 %  39 % 
, 
Inquiry  Not  Answered  20  25 %  1570  60 % 
lNumber  of beneficiaries  who  cited  a particular  problem  and  a level  of satisfaction. 
Automated  Voice $wterns 
Some  Medicare  carriers  use  automated  voice  systems  to handle  telephone  calls. 
Eighty  beneficiaries  who had  called  their  carriers  had  experienced  automated  systems. 
Table  5 shows that  more  beneficiaries  are  encountering  automated  voice  systems  in 
1993 than  in 1991. 
TABLE  5 
AUTOMATED  VOICE  SYSTEM 
13(cid:1) About  60 percent  of the  beneficiaries  using automated  voice  systems  had  encountered 
problems  with them.  Those  beneficiaries  who had  experienced  these  systems  were 
asked  to check  possible  problems  they  may have  had.  They  could  check  one  or more 
problems.  Thirty-five  beneficiaries  said they did not  have  a touch-tone  telephone  to 
respond  to the  automated  voice  system,  18 beneficiaries  said they  could  not 
understand  the  directions  given by the  system,  and  7 beneficiaries  cited  other 
problems,  such as being  disconnected  too  many  times  and  the  system  going  too  fast. 
BENEFICIARIES  USED  SOME  SPECIAL  SERVICES  OFFERED  BY MEDICARE 
We  asked  our  sample  of Medicare  beneficiaries  to provide  information  on the  extent 
they  use  a second  opinion  for surgery  and  participating  physicians. 
Second O-n  on the Need for Szugay 
Less  than  half  (39 percent)  of all the  beneficiaries  surveyed  were  aware  that  Medicare 
pays for  a second  opinion  on the  need  for surgery.  Only  19 percent  of the 
beneficiaries  who had  received  non-emergency  surgery  obtained  a second  opinion 
before  having  the  surgery. 
Table  6 shows that  the  number  of beneficiaries  who were  aware  that  Medicare  paid 
for second  opinions  has  decreased  each  of the  three  survey years. 
TABLE  6

SECOND  SURGICAL  OPINIONS(cid:1)
About  half  of all beneficiaries  (51 percent)  said they  thought  people  should  be 
required  to get  a second  opinion  from  another  doctor  to make  sure  non-emergency 
surgery  is really  necessary.  Many  beneficiaries  (44 percent)  said it would  depend  on 
the  type  of surge~  recommended.  Five  percent  of the  beneficiaries  said that  a second 
opinion  should  not  be  required. 
14(cid:1) Parlicipaling l?hysiciim I?ogmm 
Medicare  has  participating  physicians who agree  to charge  no more  than  Medicares 
approved  amount.  Medicare  pays 80 percent  of the  approved  amount.  A beneficiary 
is only responsible  for paying  a deductible  and  a 20 percent  coinsurance. 
Figure  8 shows that  the  number  of beneficiaries  who were  aware  of participating 
physicians  in 1993 has increased  when  compared  to the  1989 and  1991 surveys.  Use 
of participating  physicians  has remained  about  the  same. 
FIGURE  8 
BENEFICIARY  AWARENESS  AND USE 
1oo-
OF PARTICIPATING  PHYSICIANS 
so- Lefpltl 
AWARE OF
so- 77

USE 
70-
60-
L
So 
40 
30-
zo 
io 
n-l 
Iistl  Ii!ll  I!& 
Sixty-nine  percent  of all the  beneficiaries  surveyed  said they  had  never  called  their 
carriers  to get the  names  of participating  physicians,  and  24 percent  of those 
surveyed  said they  did not  know their  carriers  provided  this type  of information. 
CONCLUSION 
Medicare  carriers  seem  to be  doing  a better  job  this year  processing  Part  B claims 
than  in previous  years.  Most  beneficiaries  are  satisfied  with  claims  processing  and  said 
their  claims  are  processed  quickly enough.  The  number  of beneficiaries  experiencing 
problems  with  claims has  declined  since  our previous  survey. 
15(cid:1) Some  beneficiaries  do, however,  have  trouble  understanding  Medicare  payments.(cid:1)
Some  do not  understand  what  part  of a claim was paid  and  why.  Carriers  began  using(cid:1)
a revised  Explanation  of Medicare  Benefits  (EOMB)  in  1992 which  HCFA  is(cid:1)
assessing.  An OIG  study on the  EOMB  should  provide  HCFA  with specific(cid:1)
information  to help  increase  beneficiaries  understanding  of Medicare  payments.(cid:1)
Most  beneficiaries  who had  called  their  carriers  for assistance  were  satisfied  with the(cid:1)
sewice  they had  received.  Further,  the  number  of beneficiaries  experiencing  problems(cid:1)
calling  their  carriers  decreased  from  the  1991 survey.  Over  one-third  (43 percent)  of(cid:1)
the  beneficiaries  who had  called  and  experienced  a problem  said the  line was busy.(cid:1)
Carriers  may be  trying to improve  their  telephone  service  by using  automated  voice(cid:1)
systems.  However,  the  majority  of beneficiaries  using those  systems  have  problems(cid:1)
with them.  Carriers  need  to continue  their  efforts  to improve  beneficiary  access  to(cid:1)
their  semices.(cid:1)
16(cid:1) APPENDIX  A

RESPONSES  TO  1993 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. 
s	 The  sum of individual  percentages  may not  equal  100 percent  due  to 
independent  rounding. 
	 For  Questions  2, 9, 11, 19, 23, 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? 
753  75 
NO  256  25 
NO ANSWER:  44 
b.  You  can get information  about 
Medicare  when  you need  it? 
YES  730  72 
NO  76  7 
DONT  KNOW  215  21 
NO  ANSWER:  32 
c. Medicare  pays your  claims 
quickly enough? 
YEs  727  71 
NO  153  15 
DONT  KNOW  144  14 
NO  ANSWER:  29 
A-1(cid:1) Question  Responses  Percentage 
2  What  types  of medical  insurance  do you or your  spouse  have  in addition  to 
Medicare? 
(Check  all that apply) 
(N=  1010- Number  Responding  to Question) 
DO  NOT  HAVE  ADDITIONAL 
INSURANCE  COVERAGE  199  20 
MEDICAID(cid:1) 111  11 
HEALTH  INSURANCE(cid:1) THROUGH  YOUR 
OR  YOUR  SPOUSES(cid:1) CURRENT  OR 
FORMER  EMPLOYER(cid:1) 329  33 
PRIVATE  MEDICARE(cid:1) SUPPLEMENT  273  27 
CHAMPUS(cid:1) 5  .5 
OTHER(cid:1) 238  24 
NO  ANSWER:  43(cid:1)
3.  Do you feel  at this time  you are  in good  health? 
664  67 
NO  331  33 
NO  ANSWER:  58 
4. Thinking  about  the  most  recent  time  you were  a patient  in a hosuitd  for  at kast 
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  COVERAGE  352  34 
YES,  IT WAS  CLEAR  WHAT  MEDICARE 
PAID  FOR  416  40 
NO,  IT WAS NOT  CLEAR  WHAT 
MEDICARE  PAID  FOR  151  15 
I DO  NOT  REMEMBER  IF IT WAS 
CLEAR  WHAT  MEDICARE  PAID  FOR  100  10 
MEDICARE  HAS  NOT  YET  PAID  THE 
HOSPITAL  13  1 
NO ANSWER:  21 
A-2(cid:1) Question  Responses  Percentage 
5.	 Thinking  about  the  most  recent  time  you received  medical  seMces  in vow  home 
from  a home  health  a~enq,  was  it clear to you what  Medicare  paid  for? 
(Check  me  answer.) 
I HAVE  NOT  RECEIVED  MEDICAL 
SERVICES  FROM  A HOME 
HEALTH  AGENCY  SINCE  I 
HAVE  HAD  MEDICARE  783  78 
YES,  H WAS  CLEAR  WHAT 
MEDICARE  PAID  FOR  154  15 
NO,  IT WAS NOT  CLEAR  WHAT 
MEDICARE  PAID  FOR  30  3 
I DO  NOT  REMEMBER  IF IT WAS 
CLEAR  WHAT  MEDICARE  PAID  FOR  30  3 
MEDICARE  HAS  NOT  YET  PAID  FOR 
THE  HOME  HEALTH  SERVICES  12  1 
NO  ANSWER:  44 
6. Thinking  about  the  last time  you went  to the  doctor,  was it clear  to you before 
you went  what  Medicare  would  pay for? 
(Check  ~  answer.) 
I HAVE  NOT  BEEN  TO  THE 
DOCTOR  SINCE  I HAVE  HAD 
MEDICARE  36  4 
YES,  IT WAS  CLEAR  WHAT 
MEDICARE  WOULD  PAY  FOR  563  55 
NO,  IT WAS  NOT  CLEAR  WHAT 
MEDICARE  WOULD  PAY  FOR  348  34 
I DO  NOT  RECALL  74  7 
NO  ANSWER:  32 
7. Did you know before  today  that  Medicare  limits how much  doctors  can  charge 
you for specific  services? 
YEs  653  64 
NO  373  36 
NO  ANSWER:  27 
A-3  Percentage 
Responses 
Question 
8.  If you  should  ever  need  nursing home  care,  do you  have  a way  to cover  the  cost? 
362  37 
587  60 
NO  (Skip to Q-10) 
I AM  CURRENTLY  IN A 
32  3 
NURSING  HOME  (Skip to Q-n) 
NO  ANSWER:  72 
9. I&ted  below  are  some  ways people  might  pay for nursing  home  care.  Which  of 
these  would  you  rely on if you  ever  needed  nursing home  care  for more  than 5 
months? 
(Check  all that appo.) 
(N=  286- Number  Responding  to Question) 
160  56 
PERSONAL  SAVINGS 
126  44 
RETIREMENT  INCOME 
88  31 
PRIVATE  INSURANCE 
87  30 
MEDICAID 
91  32 
EQUITY  IN YOUR  HOME 
25  9 
OTHER 
NO  ANSWER:  76 
10. Many  people  think  Medicare  will pay for long-term  nursing  home  care.  It 
currently  does  not.  Before  today,  did you  think that Medime  WOD  PAY  for 
long-term  nursing home  care  for more  than 5 months? 
222  24 
YEs 
702  76 
NO 
NO  ANSWER:  97 
A-4(cid:1) Question  Responses  Percentage 
PART  2  GETPING  INFORMATION  ABOUT  MEDICARE 
11.	 The  following  are some  places  people  might  go to get  answers  if they  have 
questions  about  what  Medicare  pays for. 
Where  would  you  go to get information  about  what  Medicare  pays for? 
(Check  all that apply.) 
(N=  1025- Number  Responding  to Question) 
YOUR  DOCIORS  OFFICE(cid:1) 495  48 
A FRIEND  OR  RELATIVE(cid:1) 103  10 
AARP  OR  OTHER  MEMBERSHIP(cid:1)
ORGANIZATION(cid:1) 200  20 
INSURANCE  COMPANY  THAT(cid:1)
PROCESSES  YOUR  MEDICARE(cid:1)
CLAIMS(cid:1) 324  32 
THE  SOCIAL  SECURITY  OFFICE(cid:1) 465  45 
A LOCAL  SENIOR  CITIZENS  GROUP(cid:1) 83  8 
AN  INSURANCE  SALESPERSON(cid:1) 17  2 
THE  MEDICARE  HANDBOOK(cid:1) 552  54 
OTHER(cid:1) 40  4 
NO  ANSWER:  28(cid:1)
12 When  you have  needed  specific  information  about  what  Medicare  pays for, how 
often  were  you able  to get the  information  you needed? 
(Check  u  answer.) 
MOST  OF  THE  TIME(cid:1) 393  39 
SOME  OF THE  TIME(cid:1) 182  18 
SELDOM  OR  NEVER(cid:1) 82  8 
I HAVE  NEVER  NEEDED(cid:1)
INFORMATION  360  35 
NO  ANSWER:  36 
A-5(cid:1) Percentage 
Responses 
Question 
13.	 Listed  below  are ways  the Government  could use to tell people  about  changes  in 
the Medicare  program. 
Which way  is best  for notifying you  of Medicare  changes? 
(Please  check  ONLY  ONE.) 
(N=  1032- Number  Responding  to Question) 
ANNOUNCEMENTS  ON TELEVISION 
70  7 
AND  RADIO 
PAMPHLETS  DESCRIBING  THE 
357  34 
CHANGES  MAILED  TOME 
NOTIC~  INCLUDED  WITH  MY 
179  17 
SOCIAL  SECURITY  CHECK 
A NEW  MEDICARE  HANDBOOK 
MAILED  TOME  THAT  INCLUDES 
394  38 
THE  CHANGES 
ANNOUNCEMENTS  IN THE 
12  1 
NEWSPAPER 
SPEECHES  OR  PRESENTATIONS  BY 
1 
MEDICARE  REPRESENTATIVES  11 
9  .8 
OTHER 
NO  ANSWER:  21 
14.  How  many  times  in the  past  year  have  you used  your  Medicare  Handbook? 
(Check  ~  answer.) 
368  36 
1 TO  3 TIMES 
57  6 
MORE  THAN  3 TIMES 
I HAVE  NEVER  USED  THE 
MEDICARE  HANDBOOK 
345  34 
(skip  to Q-17) 
I DO  NOT  KNOW  WHAT  THE 
MEDICARE  HANDBOOK  IS 
27  3 
(skip  to Q-17) 
I DO  NOT  RECALL  RECEIVING 
A MEDICARE  HANDBOOK 
213  21 
(skip  to Q-17) 
NO  ANSWER:  43 
A-6(cid:1) Percentage 
Respo-
Question 
15.  Do  you  think the Medicare  Handbook  ix 
(Check  ~  answer.) 
113  27 
VERY  HELPFUL 
272  66 
GENERALLY  HELPFUL 
19  5 
GENERALLY  NOT  HELPFUL 
7  2 
NOT  HELPFUL  AT ALL 
NO  ANSWER:  14 
16.  Thinking  about  the  Medicare  Handbook  you have  receivec$ would  you say that... 
a.  The  wording  is easy to understand? 
314  80
YEs(cid:1)
78  20

NO 
NO  ANSWER:  33 
b.  The  lettering  is large  enough  to read? 
345  94 
23  6 
NO 
NO  ANSWER:  57 
c.  It covers  enough  information? 
284  85
YEs(cid:1)
51 15(cid:1)
NO 
NO ANSWER:  90 
PART  3:  MEDICARE  CLAIMS 
17. Did you know before  today  that  your  doctors  are  supposed  to file your  Medime 
claiI&  for you? 
921  90 
YEs 
100  10 
NO 
NO  ANSWER:  32 
A-7(cid:1) Question  Responses  Percentage 
18.  Ove@  how  satisfied  are you with the  way Medicare  has processed  your  claims? 
VERY  SATISFIED  378  37 
GENERALLY  SATISFIED  472  46 
NEITHER  SATISFIED  NOR 
DISSATISFIED  91  9 
GENERALLY  DISSATISFIED  26  3 
VERY  DISSATISFIED  12  1 
MEDICARE  HAS  NOT  YET 
PAID  CLAIM  39  4 
NO  ANSWER:  35 
19.	 Did you  have  any  of the following  problems  the last time  you  had  a Medicare 
claim for a doctors  visit? 
(N=  988- Number  Responding  to Question) 
(Check  as manv  as amdy.) 
I HAD  DIFFICULTY  GETTING 
INFORMATION  FROM  MEDICARE 
ON THE  STATUS  OF  MY CLAIM  27  3 
I DID  NOT  UNDERSTAND  WHAT 
PART  OF  MY  CLAIM 
MEDICARE  PAID  AND  WHY  144  15 
I DID  NOT  UNDERSTAND  WHY 
MEDICARE  DENIED  THE  CLAIM  79  8 
MEDICARE  TOOK  TOO  LONG  TO 
PAY  MY  CLAIM  85  9 
I DID  NOT  UNDERSTAND  THE 
NOTICE  MEDICARE  SENT 
AFTER  PROCESSING  MY 
CLAIM.  (THE  NOTICE  IS 
CALLED  EXPLANATION  OF 
MEDICARE  BENEFITS.  128  13 
)
I DID  NOT  HAVE  A PROBLEM 
WITH  MY  MEDICARE  CLAIM  643  65 
OTHER  34  3 
NO  ANSWER:  65 
A-8
 Question  Responses  Percentage 
PART  4  CALLING  MEDICARE 
20.	 Have  you  ever  tried to call the insurance  company  that processes  your  Medicare 
claims? 
YES  - Month  and  Year  of Last  Call:  288  29 
NO  (Skip to 026)  708  71 
NO  ANSWER:  57 
21.	 Thinking  about  the last time you  tried to @  how  many  tries did it take you  to 
reach  them? 
(Check  =  answer.) 
FIRST  TRY  95  35 
SECOND  TRY  71  25 
THREE  OR  MORE  TRIES  85  32 
NEVER  GOT  THROUGH  22  8 
NO ANSWER:  15 
22.  How  satisfied  were  you with  the service  you  received  the last time  you  called? 
(Check  me  answer.) 
VERY  SATISFIED  87  31 
GENERALLY  SATISFIED  119  43 
NEITHER  SATISFIED  NOR 
DISSATISFIED  32  12 
GENERALLY  DISSATISFIED  25  9 
VERY  DISSATISFIED  13  5 
NO  ANSWER:  12 
A-9(cid:1) Question  Responses  Percentage 
23.	 J&ted  below  are possible  problems  someone  might have  when  calling the 
Medicare  insurance  company. 
Did you  have  any problems  the last time you  called? 
(N=  230- Number  Responding  to Question) 
(Check  as many  as apply.) 
I WAS  NOT  ABLE  TO  GET  MY 
QUESTION  ANSWERED  20  9 
THE  LINE  WAS BUSY  100  43 
I GOT  DIFFERENT  ANSWERS 
FROM  DIFFERENT  PEOPLE  39  17 
I WAS PUT  ON  HOLD  TOO  LONG  63  27 
I COULD  NOT  UNDERSTAND 
THE  ANSWER  THEY  GAVE  ME  23  10 
THE  PERSON  ANSWERING  THE 
CALL  WAS NOT  VERY 
COURTEOUS  23  10 
I DID  NOT  HAVE  A PROBLEM 
WITH  THE  SERVICE  I RECEIVED  116  50 
OTHER  7  3 
NO  ANSWER:  58 
24.	 Some  Medicare  insurance  companies  use an automated  voice  system  to handle 
telephone  calls. 
Thinking  about  the  last time  you called  the  Medieare  insurance  company  that 
processes  your  cl- how was your  cdl  answered? 
BY AN AUTOMATED  VOICE  80  31 
BY A MEDICARE  EMPLOYEE  177  69 
(skip  to Q-26) 
NO  ANSWER:  37 
A-10(cid:1) Responses  Per=ntage 
Question 
25.	 T.isted below  are possible  reasons  that someone  would  be  dissatisfied  with  fig 
the Medieare  insurance  company  and getting  an automated  voice. 
Did you  have  any of these  problems  the last time you  called? 
(N  =  48- Number  Responding  to Question) 
(Check  as many  as a@!.) 
I DID  NOT  HAVE  A TOUCH-TONE 
TELEPHONE  TO  RESPOND  TO 
73
THE  AUTOMATED  VOICE  SYSTEM  35 
I COULD  NOT  UNDERSTAND  THE 
DIRE~IONS  GIVEN  BY THE 
18  38 
AUTOMATED  VOICE  SYSTEM 
7  14 
OTHER 
NO  ANSWER:  32 
PART  5:  APPEALING  CLAIMS 
26.	 sometimes  people  disagree  with  the  decisions  made  on their Medieare  claims. 
When  this happens,  you  may  appeal  or request  a review  of those  deeisiom. 
Did you  know  before  todav  that you  could  appeal  or request  a review? 
75 
749 
254  25 
NO 
NO  ANSWER:  50 
27.  Have  you  ever  appealed  a decision  made  by Medime  on a claim you  submitted? 
6 
60 
94 
904 
NO  (SkiP to @30) 
NO  ~S-~R:  89 
28.  Did you  understand  the final decision  made  on your  claim? 
35  65 
19  35 
NO 
NO  ANSWER:  6 
A-n  Question  Responses  Percentage 
29.  Do  you  think your  appeal  was  handled  fairly? 
28  59 
NO  20  41 
NO  ANSWER:  12 
PART  &  GETTING  SECOND  OPINIONS 
30.	 If your  doctor  recommends  that you  have  surgery,  Medicare  will help you  pay  to 
get  the opinion  of another  doctor  to make  sure the  surgery  is really  necessary. 
Were  you  aware  before  today  that Me&are  would  help  to pay  for you  to get  a 
second  opinion  before  having  surgery? 
397  39 
NO  624  61 
NO  ANSWER:  32 
31.	 Do  you  think people  should be  required  to get  a second  opinion  from  another 
doctor  to make  sure non-emergency  surge~  is really necessary? 
YEs  526  51 
NO  49  5 
DEPENDS  ON THE  TYPE  OF 
SURGERY  447  44 
NO  ANSWER:  31 
32.	 Thinking  about  the last time you  had non-emergency  surgery,  did you  get  a 
second  doctors  opinion  before  having  the surgery? 
185  19 
NO  425  43 
I HAVE  NEVER  HAD 
NON-EMERGENCY  SURGERY  382  39 
NO  ANSWER:  61 
A-12(cid:1) Question  Respmses  Percentage 
PART  7  PARTICIPATING  DOCIORS  PROGRAM 
33.	 Medieare  has participating  doctors who  agree  to charge  no more  than 
Medicares  approved  amount.  Medicare  pays  80%  of the approved  amount  You 
are only responsl~le  for paying  the deduetiile  and the 20%  coinsurance. 
Before  today,  had you  ever  heard  about  Medicare  participating  doctors? 
YEs  853  83 
NO  172  17 
NO  ANSWER:  28 
34.  Are  any of your  doctors  participating  doctors? 
677  65 
NO  94  9 
DONT  KNOW  262  25 
NO ANSWER:  20 
35.	 Have  you  ever  contacted  the insurance  company  that processes  your  Medicare 
claims to get the names  of doctors  who  are  participating  doctors? 
65  6 
NO  703  69 
I DID  NOT  KNOW  I COULD  GET 
THIS  INFORMATION  FROM  THE 
INSURANCE  COMPANY  THAT 
PROCESSES  MY CLAIMS  246  24 
NO  ANSWER:  39 
36.  Thinking  about  the future,  how  likely are you  to select  a participating  doctor for 
health  care  seMces? 
(Check  ~  answer.) 
LIKELY  TO  SELECT 
PARTICIPATING  DOCTOR  634  65

NOT  LIKELY  TO  SELE~ 
PARTICIPATING  DOCTOR  78  8

WILL  NOT  MATTER  IF DOCTOR 
IS PARTICIPATING  262  27

NO  ANSWER:  79 
A-13(cid:1) APPENDIX  B

COMPARISON  TO THE  1989  AND  1991  SURVEYS 
L  S~  BETWEEN  THE  SURVEYS 
The  majority  of the  questions  from  the  1991 Medicare  Beneficiary  Survey  (OEI-04-90-
89030) were  used  in the  1993 suxvey.  Twenty-nine  questions  from  the  1991 survey 
were  essentially  duplicated  in the  1993 survey. 
IL  DIFFERENCES  BETWEEN  THE  SURVEYS 
The  1993  survey  was  designed  to offer  a greater  number  of optional  responses,  such  as 
the  possibility  of not  having  experienced  a problem  or not  recalling  a particular  issue. 
We  tried  to eliminate  skip to situations,  so we  combined  questions  wherever  possible. 
For  example,  in  1991,  we  first asked  beneficiaries  if they  had  ever  received  medical 
services  in their  home  from  a home  health  agency.  If they  had  not,  beneficiaries  were 
asked  to  skip  questions.  Then,  we  asked  only  those  who  had  received  such  sefices  if 
it was  clear  what  Medicare  paid  for.  In the  1993  survey,  we  asked  only  one  question 
(Question  5) about  home  health  agencies.  This question  included  three  additional 
options  that  the  1991 survey did not  include.  The  three  options  were  I have  not 
received  medical  services  from  a home  health  agency..., I do not  remember  if it was 
clear  what  Medicare  paid  for, and  Medicare  has not  yet paid  for the  home  health 
services. 
Reszxmre Rates 
In 1989 and  1991, the  response  rates  to our  surveys were  65 and  83 percent, 
respectively.  The  response  rate  to our  1993 survey was 84 percent. 
HI.	 FINDINGS  OF SIGNIFICANT  DIFFERENCE  BETWEEN  THE  THREE 
SURVEYS 
Where  sufficient  similarities  existed  between  questions  in the  three  surveys, we 
compared  responses  to determine  if differences  were  statistically  significant.  We 
determined  significant differences  by using the  t-test.  Our  purpose  was to determine 
whether  the  three  surveys reflect  significant  differences  regarding  beneficiaries 
experience  and  satisfaction  over  the  three  survey years. 
B-1(cid:1) Because  we offered  more  options  for beneficiary  responses  to questions  in the  1993 
survey, we could  not  do a direct  comparison  to determine  changes  in levels  of 
satisfaction  for all Medicare  issues. 
B-2(cid:1) APPENDIX  C
ANALYSIS  OF RESPONDENTS  VS.  NON-RESPONDENTS 
A  consideration  in surveys of this type  is that  the  results  maybe  biased  if the  non-
respondents  are  significantly  different  from  the  respondents.  To  determine  whether 
significant  differences  exist in this survey, we performed  various  analyses,  including  a 
comparison  of the  age  and  gender  for the  1053 respondents  and  the  204 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 74, compared  to age  77 for non-respondents.  A 
means  test  revealed  that  the  difference  in average  ages for the  two groups  was 
statistically  significant.  Therefore,  to analyze  for potential  bias  related  to age, we 
divided  respondents  into  two groups,  those  younger  than  73 1/2 and  those  older  than 
that  age.  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  t-tests  revealed  no  statistically 
significant  differences  between  responses  to those  questions  by younger  beneficiaries 
and  responses  by older  beneficiaries.  That  is, the  frequency  of positive  and  negative 
responses  for the  two age groups  was not  significantly  different.  Therefore,  no 
statistical  evidence  of age bias was shown. 
ANALYSIS  BY  GENDER 
The  analysis by gender  showed  that  the  distribution  of male  and  female  respondents 
was not  comparable  to the  distribution  of non-respondents. 
s@!l&  ,j&ijii?h@&J@ 
: 
&% 
42%  31% 
FEMALE  60%  58%  69% 
Due  to the  significant  percentage  differences  between  male  and  female  respondents 
versus  non-respondents,  additional  analysis was necessary. 
Using  three  questions  (Questions  la,  lb,  and  lc)  on the  questionnaire  as key 
questions,  we concluded  there  was an absence  of bias  among  the  sexes.  The  positive 
c-1  (YES)  responses  to the  key questions  were,  cumulatively,  71 percent  for male 
respondents  and  70 percent  for female  respondents. 
ANALYSIS  BY  TIME  OF RESPONSE 
As an additional  guard  against  obtaining  biased  results,  some  suxveys 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 test  for possible  late  response  bias  in this survey, the  first  800 responses  (76 
percent)  were  compared  to the  last 253 responses. 
Again,  three  key questions  were  used  for analysis.  The  early  responses  to the  key 
questions  were,  cumulatively,  65 percent  positive.  The  later  responses  were  63 percent 
positive.  The  difference  of two percentage  points  is not  statistically  significant. 
c-2