The effects of prepayment on access to medical care: the PACC experience

The data reported herein are taken from a larger study in which a prepaid medical foundation was compared with a non-prepaid free-for-service system on a number of factors pertaining to how health care is perceived by both Medicaid recipients and physicians. The data to be presented are confined to the issue of the impact of prepayment on Medicaid recipients' perceptions of their access to health care. Two sets of questions are explored. The first set bears directly on the issue of gaining access to care. The second set addresses the issue of the acceptability of the services received. Few differences were observed between the systems in either accessibility or acceptability. Thus, the fears of some critics of the HMO concept with respect to prepayment creating incentives for the denial of services are not supported by the data. It is concluded that the organizational features of medical practice which affect access are actually quite similar in the two systems.