Consumer surveys of health plan performance: a comparison of content and approach and a look to the future.

BACKGROUND

Escalating demand in the market-place for consumer-supplied data on health plan performance has led to a growing number of competing survey instruments. Many of them offer distinct perspectives on what concepts should be measured and how they should be measured. The principal user groups of this information-purchasers, consumers, and health plans-face an increasingly complex decision when choosing between instruments.

DIALECTIC OF SURVEY DEVELOPMENT

Many of the differences between surveys arise because the three user groups apply survey results for different purposes. At the same time, a standardized instrument would provide the three user groups more information and context. A dialectic process between these two dynamics is guiding the exchange between survey developers and users and is resulting in slow if somewhat unsteady progress toward consensus on common core content across user groups.

SIX CONSUMER SURVEYS

This article seeks to promote public debate on the content and approach of consumer surveys of plan performance, a task that is separate from comparative empirical testing. Six instruments are described-the Consumer Satisfaction Survey, Employee Health Care Value Survey, Health Plan Value Check, Adult Health Care Survey, Annual Member Health Care Survey-Version 1.0, and the Consumer Health Plan Value Survey. To help differentiate the instruments, several common methodologic choice points faced by each (for example, use of "not applicable" as an option) are highlighted. The alternative approaches taken by the instruments to address these choice points are discussed in terms of the arguments for and against their use.

ANTICIPATING THE FUTURE

Although it is too early to predict which survey measures or approaches will figure most heavily in the eventual core instrument, it is not too early to anticipate that the critical decisions will be made on both academic (for example, psychometric and cognitive testing) and marketplace criteria. Increasingly influential will be collective user prerequisites emerging out of the interplay of the three user groups in the marketplace. Six key collective prerequisites (for example, defining common ground between the user groups) are identified, and their likely impact on the development of consumer surveys of health plan performance are described.