To the Editor.
—The article by Dr Sisk and colleagues1 heralds an upcoming wave of evaluations of state Medicaid managed care programs. We believe this research makes an important contribution by highlighting the self-reported experiences of Medicaid managed care enrollees. However, we have several concerns that temper our enthusiasm for their conclusion that New York State's managed care initiative is successful in achieving many of its goals.Two items from the Visit Specific Satisfaction Questionnaire were added to the Group Health Association of America's Consumer Satisfaction Survey.2 Presumably, the authors accounted for the reverse coding of these items (rating from excellent to poor). Even so, the addition of these items, plus a new item (cost), may have substantially modified the psychometric properties of the Consumer Satisfaction Survey instrument. We suggest the authors check the reliability and validity of the modified satisfaction instrument.The authors translated the modified satisfaction instrument to accommodate