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. 1991 Oct;26(4):509–529.

Medicaid beneficiaries under managed care: provider choice and satisfaction.

H Temkin-Greener 1, M Winchell 1
PMCID: PMC1069838  PMID: 1917503

Abstract

This study describes patterns of choosing a provider and of consumer satisfaction among prepaid Medicaid beneficiaries in Monroe County, New York, and compares their level of satisfaction to that of fee-for-service Medicaid beneficiaries. Two interview surveys were conducted with AFDC and HR (general assistance) Medicaid eligibles, the first under the fee-for-service system servicing the Medicaid population, and the second 18 months after the introduction of a mandatory, prepaid managed care system for Medicaid beneficiaries. The results show significant ethnic differences in patient choice of provider and provider site. Given the choice, Medicaid beneficiaries switch from clinics as their usual source of care to private physician practice. Under prepayment, white Medicaid beneficiaries tripled their affiliations with private doctors, while "others" doubled theirs. The results also demonstrate higher levels of patient satisfaction with "humaneness of doctors" and with "quality of care" among those beneficiaries under prepaid care, than previously documented for those under fee-for-service. The evaluations of humaneness and quality of medical system may reflect the respondents' perceptions that the process of receiving care under prepaid, managed care is somehow different, no longer second class, and better that it was under the fee-for-service Medicaid.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bice T. W., Rabin D. L., Starfield B. H., White K. L. Economic class and use of physician services. Med Care. 1973 Jul-Aug;11(4):287–296. doi: 10.1097/00005650-197307000-00002. [DOI] [PubMed] [Google Scholar]
  2. Davies A. R., Ware J. E., Jr, Brook R. H., Peterson J. R., Newhouse J. P. Consumer acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial. Health Serv Res. 1986 Aug;21(3):429–452. [PMC free article] [PubMed] [Google Scholar]
  3. Dutton D. B. Explaining the low use of health services by the poor: costs, attitudes, or delivery systems? Am Sociol Rev. 1978 Jun;43(3):348–368. [PubMed] [Google Scholar]
  4. Freeborn D. K., Pope C. R., Davis M. A., Mullooly J. P. Health status, socioeconomic status and utilization of outpatient services for members of a prepaid group practice. Med Care. 1977 Feb;15(2):115–128. doi: 10.1097/00005650-197702000-00002. [DOI] [PubMed] [Google Scholar]
  5. Friedman E. Opposition to medicaid restructuring is stronger and more varied than expected. Hospitals. 1983 Oct 1;57(19):67-8, 71-2, 75-9. [PubMed] [Google Scholar]
  6. Gray L. C. Consumer satisfaction with physician provided services: a panel study. Soc Sci Med. 1980 Jan;14A(1):65–73. [PubMed] [Google Scholar]
  7. Greenlick M. R., Freeborn D. K., Colombo T. J., Prussin J. A., Saward E. W. Comparing the use of medical care services by a medically indigent and a general membership population in a comprehensive prepaid group practice program. Med Care. 1972 May-Jun;10(3):187–200. doi: 10.1097/00005650-197205000-00001. [DOI] [PubMed] [Google Scholar]
  8. Like R., Zyzanski S. J. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24(4):351–357. doi: 10.1016/0277-9536(87)90153-5. [DOI] [PubMed] [Google Scholar]
  9. Luft H. S. Assessing the evidence on HMO performance. Milbank Mem Fund Q Health Soc. 1980 Fall;58(4):501–536. [PubMed] [Google Scholar]
  10. Marquis M. S., Davies A. R., Ware J. E., Jr Patient satisfaction and change in medical care provider: a longitudinal study. Med Care. 1983 Aug;21(8):821–829. doi: 10.1097/00005650-198308000-00006. [DOI] [PubMed] [Google Scholar]
  11. Merkel W. T. Physician perception of patient satisfaction. Do doctors know which patients are satisfied? Med Care. 1984 May;22(5):453–459. doi: 10.1097/00005650-198405000-00009. [DOI] [PubMed] [Google Scholar]
  12. Murray J. P. A comparison of patient satisfaction among prepaid and fee-for-service patients. J Fam Pract. 1987 Feb;24(2):203–207. [PubMed] [Google Scholar]
  13. Rabin D. L., Bice T. W., Starfield B. Use of health services by Baltimore Medicaid recipients. Med Care. 1974 Jul;12(7):561–570. doi: 10.1097/00005650-197407000-00002. [DOI] [PubMed] [Google Scholar]
  14. Rundall T. G., Wheeler J. R. The effect of income on use of preventive care: an evaluation of alternative explanations. J Health Soc Behav. 1979 Dec;20(4):397–406. [PubMed] [Google Scholar]
  15. Spitz B. When a solution is not a solution: Medicaid and Health Maintenance Organizations. J Health Polit Policy Law. 1979 Winter;3(4):497–518. doi: 10.1215/03616878-3-4-497. [DOI] [PubMed] [Google Scholar]
  16. Temkin-Greener H. Medicaid families under managed care. Anticipated behavior. Med Care. 1986 Aug;24(8):721–732. doi: 10.1097/00005650-198608000-00007. [DOI] [PubMed] [Google Scholar]
  17. Tessler R., Mechanic D. Consumer satisfaction with prepaid group practice: a comparative study. J Health Soc Behav. 1975 Mar;16(1):95–113. [PubMed] [Google Scholar]
  18. Ware J. E., Jr, Brook R. H., Rogers W. H., Keeler E. B., Davies A. R., Sherbourne C. D., Goldberg G. A., Camp P., Newhouse J. P. Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care. Lancet. 1986 May 3;1(8488):1017–1022. doi: 10.1016/s0140-6736(86)91282-1. [DOI] [PubMed] [Google Scholar]
  19. Ware J. E., Jr, Snyder M. K. Dimensions of patient attitudes regarding doctors and medical care services. Med Care. 1975 Aug;13(8):669–682. doi: 10.1097/00005650-197508000-00006. [DOI] [PubMed] [Google Scholar]
  20. Zastowny T. R., Roghmann K. J., Hengst A. Satisfaction with medical care: replications and theoretic reevaluation. Med Care. 1983 Mar;21(3):294–322. doi: 10.1097/00005650-198303000-00004. [DOI] [PubMed] [Google Scholar]

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