Surveying Consumer Satisfaction to Assess Managed-Care Quality: Current Practices
Gold, Marsha, Wooldridge, Judith, Health Care Financing Review
Managed-care plans are a substantial and growing share of the health insurance market (Gabel et al., 1994). Because managed care integrates financing with service delivery, overseeing quality and access to health care within individual plans is very important (Kongstevdt, 1993). Some of this can be done by formal assessment of clinical quality using medical records, administrative systems, or similar information. However, these sources are not well suited to measuring the perceptions of health plan customers. For identifying consumer perspectives, surveys are a useful tool, providing more systematic data to complement information from grievance systems and other sources of consumer feedback. Consumer surveys are receiving increased attention (Agency for Health Care Policy and Research, forthcoming) as a component of Total Quality Management and Continuous Quality Improvement to enhance quality of care and service (James, 1994; Press, Ganey, and Malone, 1992; Inguanzo, 1992; Kritchevsky and Simmons, 1991; Berwick, 1989). Though some controversy exists about the role of consumer information in monitoring quality (Goldfield, Pine, and Pine, 1991), most researchers, policymakers, and managers agree that consumer satisfaction is an important measure of quality and, hence, of system and health plan performance (Cleary and McNeff, 1988; Davies and Ware, 1988; Press, 1994a). However, because many of these applications are operational, they are poorly documented in the published literature, a shortcoming we aim to remedy in this article.
As more of the population enrolls in managed care, there has been an increasing policy focus on use of consumer satisfaction surveys to provide information to purchasers and consumers to assist them in making choices among plans. This article discusses the types of agents collecting and disseminating consumer satisfaction information for these purposes.
FOCUS AND APPROACH
This article discusses the nature and use of consumer surveys for generating information on satisfaction with individual health plans, including health maintenance organizations (HMOs), other managed-care products such as preferred provider organizations (PPOs) and point-of-service (POS) arrangements, and traditional indemnity insurance. We summarize current knowledge about how widely surveys are used or encouraged by diverse parties such as individual managed-care plans, government and voluntary oversight agencies, community and consumer groups, and public and private purchasers of care. Next, we review the different kinds of surveys (e.g., all enrollees, system users, users of particular services), survey content, and survey methods. Then, we consider outstanding issues relevant to using consumer surveys to assess plan quality and particularly to compare health plans. We end with brief conclusions on surveys as tools for assessing care and recommend three types of activities to better support such efforts. Our approach to analyzing surveys on consumer satisfaction with health care plans was shaped largely by the data available to us. Information about surveys of consumer satisfaction with managed-care plans is evolving rapidly and is not part of the formal literature. Furthermore, most surveys are intended to address operational needs rather than research objectives. As a result, this article relies heavily on information from the trade press and unpublished materials. These were obtained by reviewing materials we had, making calls to plans known or thought to be involved in survey efforts, and referencing bibliographies and collections maintained in the Group Health Association of America (GHAA) library.
Our methods generated information on the most publicized and broad-based surveys as of mid-1994. This article is not intended to provide a complete inventory of surveys. Furthermore, it contains only limited information on the nationwide prevalence of the approaches illustrated. …