Evaluation of Selected Aspects of the National Medicare Education Program: Final Design Report. 4.1.4 Independent Variables/Factors


The MCBS includes a number of descriptive variables of beneficiaries that can be used to examine differences among groups: age, gender, race, Hispanic ethnicity, educational attainment, marital status, self-reported health status, urbanicity, cable TV and Internet access, type of supplemental coverage (e.g., employer-sponsored, privately purchased supplemental coverage, Medicaid), whether coverage eligibility was due to age or disability, and detailed information on charges and use of medical services.

Research Questions

Previously Fielded MCBS Questions (Paraphrased and MCBS Survey Item Number): Outcome Measures

Topics for New Survey Questions (Paraphrased)

Table 4-1. Research Questions and Potential MCBS Survey Questions

Access to Sources of Information

Do beneficiaries have access to information from Medicare when they need to make changes in their benefits or coverage?

Whether beneficiaries received the Medicare & You handbook (KN27).

Whether beneficiaries still have the handbook (KN30).

Whether beneficiaries know they can call the 1-800 Helpline with questions. Whether beneficiaries know they can contact their local SHIP with questions. Whether beneficiaries know they can look on the Medicare Web site.

What source(s) of Medicare information do beneficiaries have access to?

Beneficiary information sources identified (both the NMEP and other) concerning cost of particular medical service (KN3 and 4), prescription drug coverage (PD16), new benefits or changes in Medicare (KN6 and 7), what Medicare covers or does not cover (KN9 and 10), availability and benefits of Medicare HMOs and PPOs (KN12 and 13), Medigap or supplemental insurance (KN15 and 16), Medicaid plan (KN18 and 19).

New questions are not needed.

Is access to information increasing over time?

Questions on information sources (see above) have been asked over multiple years and so this question can be answered by measuring changes in the cohort over time.

New questions are not needed.

Knowledge of the Medicare Program

Do beneficiaries understand Medicare’s features and options?

Prior surveys contain a series of questions with responses of true/false/not sure, concerning such topics as Medicare eligibility (KN37), eligibility for prescription drug coverage (KN42), what Medicare HMO coverage (KN43), etc. (see also KN44-46).

Because the true/false format lends itself to guessing, new questions/responses on particular topics of interest could be reworded to more reliably capture beneficiary knowledge.

Does individual beneficiary understanding improve with longer tenure in the program?

Because individual beneficiaries remain in the MCBS for up to 4 years, changes in individual responses can be tracked over time.

New questions must be added if it is felt that beneficiaries learn through responding to existing questions or if topics of interest are not covered through existing questions.

Is beneficiary understanding of the Medicare program’s features and options increasing over time?

Because questions are repeated over time, the percentage of beneficiaries answering correctly can be tracked.

New questions are not needed to track change.

Is use of particular NMEP interventions or combination of interventions related to greater knowledge of key Medicare program concepts or new prescription drug features?

The current survey has no mechanism to directly measure whether understanding of Medicare is related to use of an NMEP interventions. (Prior analyses have attempted to answer this question by correlating understanding with use.)

To answer this question, new questions need to have two parts: (1) establish level of knowledge and (2)recall of where knowledge was obtained. Questions must be limited to newly obtained knowledge to avoid recall problems.

Understanding of NMEP Materials

Do beneficiaries understand the information they receive?

Prior surveys asked about understanding specific aspects of the handbook (KN29 and 29a).

Prior surveys contain data on where beneficiaries said they found information on a topic and whether their questions were answered. These questions could be modified to ask where beneficiaries sought information on a topic and if they understood the information they received.

Can beneficiaries use the information they receive to make informed decisions?

Prior surveys asked whether beneficiaries read the handbook (BK30), used it to get a telephone number (BK31), or to find out about health plan options (BK32) .

New questions could ask whether beneficiaries understood the information they received from the Helpline, Web site, or SHIPs. Other questions could provide an example of print or Web material and determine if the information was understood.

Is beneficiaries’ level of understanding changing over time?

Questions concerning understanding of the handbook have been repeated over time (KN29b).

Questions or exercises examining print material other than the handbook/Web materials could be repeated over time with new survey cohorts to measure whether understanding is increasing.

Using NMEP Materials

To what extent are beneficiaries using NMEP information to make choices?

Information identified above to indicate access could also be used to determine which NMEP materials are used in relation to such topics as the cost of a particular medical service, prescription drug coverage, new benefits or changes in Medicare, what Medicare covers or does not cover, availability and benefits of Medicare HMOs and PPOs, Medigap or supplemental insurance, Medicaid plan

Among beneficiaries who used more than one source of information, additional questions could probe the role of various sources. For example, beneficiaries may rely on the handbook for more general questions, while the Helpline may be primarily used to address concerns that are relatively unique to the individual.

Are the particular NMEP sources of information changing over time?

Questions are repeated over time and can track cohort changes over time.

New questions should be included for more than 1 year to track change over time.

What are important sources of information used by beneficiaries other than those provided through NMEP?

Existing questions concerning information sources include options other than NMEP information sources.

New questions are not needed to address this issue.


Identifying differences among demographic groups would be determined through modeling and not survey questions (see Section 4.1.4).

Analysis would be conducted in relation to outcomes of interest.

Analysis would be conducted in relation to outcomes of interest.

In addition, respondents can be grouped by the degree to which they make their own health care decisions (those who say they make their own decisions, those who say they receive assistance, and those who are so infirm that a proxy is used to respond to the survey).

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