A comparison of patient satisfaction among prepaid and fee-for-service patients

This study compares levels of patient satisfaction (a valid, indirect measurement of quality of care) between prepaid and fee-for-service patients. A chart audit approach was used to determine whether prepaid and fee-for-service patients seen in an academic family health center at the end of the first six months of a new cost-containment program were comparable in terms of demographic characteristics and indirect measures of health and health behavior. Next, using a 26-item patient satisfaction questionnaire, 436 patients from a single group of providers in the same family health center seen six months after the programs began were randomly surveyed. Sociodemographic and health-related characteristics of prepaid and fee-for-service patients were similar for both groups in the chart audit. There was no statistically significant difference between the overall satisfaction levels of prepaid and fee-for-service patients. Individual constructs that comprise general satisfaction were also statistically similar except for an unexpected finding of dissimilar levels of satisfaction with "physician conduct/humaneness" (P less than .05). Assessed from at least one standpoint, cost containment does not seem to affect overall quality of care, but further investigation is needed, especially in the realm of "physician conduct/humaneness."