Address correspondence to Marc N. Elliott, Ph.D., RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138. Megan K. Beckett, Ph.D., Katrin Hambarsoomians, M.S., and Ron D. Hays, Ph.D., are with the RAND Corporation, Santa Monica, CA. Kelly Chong, Ph.D.(C), is with the UCLA School of Public Health, Department of Health Services, Los Angeles, CA.
How Do Proxy Responses and Proxy-Assisted Responses Differ from What Medicare Beneficiaries Might Have Reported about Their Health Care?
Article first published online: 7 JAN 2008
No claim to original U.S. government works. © Health Research and Educational Trust
Health Services Research
Volume 43, Issue 3, pages 833–848, June 2008
How to Cite
Elliott, M. N., Beckett, M. K., Chong, K., Hambarsoomians, K. and Hays, R. D. (2008), How Do Proxy Responses and Proxy-Assisted Responses Differ from What Medicare Beneficiaries Might Have Reported about Their Health Care?. Health Services Research, 43: 833–848. doi: 10.1111/j.1475-6773.2007.00820.x
- Issue published online: 7 JAN 2008
- Article first published online: 7 JAN 2008
- Beneficiary evaluation of health care experiences;
- methodological study;
- consumer reports
Objective. Assess proxy respondent effects on health care evaluations by Medicare beneficiaries.
Data Source. 110,215 respondents from the nationally representative 2001 CAHPS® Medicare Fee-for-Service Survey.
Study Design/Data Collection/Extraction Methods. We compare the effects of both proxy respondents and proxy assistance (reading, writing, or translating) on 23 “objective” report items and four “subjective” global measures of health care experiences using propensity-score-weighted regression. We assess whether proxy effects differ among spouses, other relatives, or nonrelatives.
Principal Findings. Proxy respondents provide less positive evaluations of beneficiary health care experiences than otherwise similar self-reporting beneficiaries for more subjective global ratings (average effect of 0.21 standard deviations); differences are smaller for relatively objective and specific report items. Proxy assistance differences are similar, but about half as large. Reports from spouse proxy respondents are more positive than those from other proxies and are similar to what would have been reported by the beneficiaries themselves. Standard regression techniques may overestimate proxy effects in this instance.
Conclusions. One should treat proxy responses to subjective ratings cautiously. Even seemingly innocuous reading, writing, and translation by proxies may influence answers. Spouses may be accurate proxies for the elderly in evaluations of health care.