Differences in the structure of CAHPS (R) measures among the Medicare fee-for-service, Medicare managed care, and privately insured populations

Objective. To confirm in a new population, the Medicare fee-for-service pop ulation, the factor structure previously found in two Consumer Assessment o f Health Plans Study (CAHPS (R)) field-test surveys with Medicare HMO and a dult privately insured populations. Data Sources. Primary data were collected in the fall of 1998. Survey respo nses from the Medicare Fee-for-Service CAMPS survey field test were compare d to results from the Medicare HMO and adult privately insured field-test s tudies conducted in the fall of 1996. Study Design. Respondents for the field-test survey were a random sample of Medicare beneficiaries in five states who had opted for the original Medic are plan (fee-for-service). Data Collection. Data were collected by a mailed survey with a telephone fo llow-up survey to those who did not return the mailed survey. Principal Findings. A confirmatory factor analysis in two different samples of Medicare fee-for-service beneficiaries provided basic support for a pre viously reported three-factor structure underlying the CAMPS reports and ra ting items: (1) quality of provider or staff communications; (2) timely acc ess to quality health care; and (3) quality of plan administration. An expl oratory factor analysis revealed a variant three-factor structure. Conclusion. Because of differences in the factor structures among the diffe rent populations discussed, caution needs to be exercised in any composite development, based on factor analysis or any other basis, by which cross-po pulation comparisons will be made. Comparisons should only be made on compo sites representing stable structure across all populations concerned.