Medicaid beneficiaries under managed care: provider choice and satisfaction

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.