The relationship between pre-enrollment expectation, contemporary experience, disconfirmation, satisfaction, and re-enrollment decision in a health maintenance organization / Jane McCormick Hogan.

Format:

Book

Manuscript

Microformat

Thesis/Dissertation

Author/Creator:

Hogan, Jane McCormick.

Contributor:

Lynaugh, Joan, advisor.

University of Pennsylvania.

Language:

English

Subjects (All):

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Nursing.

Academic Dissertations as Topic.

Medical Subjects:

Nursing.

Academic Dissertations as Topic.

Local Subjects:

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Physical Description:

xiii, 232 pages : illustrations ; 29 cm

Production:

1991.

Summary:

The purpose of this study was to describe the antecedents of HMO satisfaction and re-enrollment and the relationship of these concepts within the context of expectation-performance theory. A pretest-postest design was used for this longitudinal cohort analysis. The sample was composed of 568 respondents who had had no experience with the investigated HMO prior to being surveyed. Two survey instruments were developed and administered to the sample. The first survey measured pre-enrollment expectations and the second measured actual (contemporary) experience and the agreement between expectations and contemporary experience (disconfirmation), satisfaction and re-enrollment plans.

Factor analysis was used as the basis for 16 multi-item subscales which measured "Insurance" and "Delivery" expectation, contemporary experience, disconfirmation, and satisfaction. "Delivery" also had two subcomponents--"Care" and "Service." These subscales, one overall measure of diconfirmation, and 3 single item measures of satisfaction were entered into a series of logistic regression models to determine the probability of re-enrollment as a function of satisfaction, disconfirmation, contemporary experience, and expectation. Standard multiple regression was used to determine the probability of satisfaction as a function of disconfirmation, contemporary experience, and expectation. A series of nested heirarchial models were fit using likelihood ratio test. Significance levels for individual regression coefficients were calculated using standard maximum likelihood theory.

The majority of the respondents reported higher expectations of the HMO than with previous experiences, same or better contemporary experience as their previous experience with insurance and delivery, positive disconfirmation, high levels of satisfaction and plans to re-enroll. Little variability was found on all the variables and all were positively correlated.

Re-enrollment was directly predicted by satisfaction, disconfirmation and contemporary experience, while satisfaction was directly predicted by disconfirmation, contemporary experience, and expectation. Within these variables "Delivery" had a greater effect than "Insurance"; and within "Delivery"--"Care" dominated "Service". Therefore, while HMO enrollees found this form of delivery and insurance satisfying, when making postusage decisions they were more concerned about "Quality of Care" than either cost or service. In addition members perceptions, about actual experience and whether their actual experience confirmed their expectations, were more important than initial expectations in satisfying and retaining members.

Notes:

Supervisor: Joan Lynaugh.

Thesis (Ph.D. in Nursing) -- Graduate School of Arts and Sciences, University of Pennsylvania, 1991.

Includes bibliographical references.

Local Notes:

University Microfilms order no.: 92-11939.

OCLC:

80202681