Voting with their feet: public hospitals, health reform, and patient choices

This study identified public hospital patients' preferences under managed care and health reform.

A cross-sectional survey of 348 ambulatory public hospital patients was conducted.

Patients reported a high degree of loyalty to the public hospital given several hypothetical reform scenarios. Those patients who stated they would remain at the hospital increased (from 74.2% to 85.5%) when care elsewhere required copayment for medications and physician visits.

Patients at one public hospital reported a high likelihood of remaining in the public system, and this likelihood increased when copayment for services was required elsewhere.