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Health Serv Res. 1986 August; 21(3): 429–452.
PMCID: PMC1068962

Consumer acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial.


Do consumers find the care provided by health maintenance organizations (HMOs) and that provided in the fee-for-service (FFS) system equally acceptable? To address this question, we randomly assigned 1,537 people ages 17 to 61 either to FFS insurance plans that allowed choice of physicians or to a well-established HMO. We also studied 486 people who had already selected the HMO (control group). Those who had chosen the HMO were as satisfied overall with medical care providers and services as their FFS counterparts. The typical person assigned to the HMO, however, was significantly less satisfied overall relative to FFS participants. Attitudes toward specific features of care favored both FFS and HMO, depending on the feature rated. Four differences (length of appointment waits, parking arrangements, availability of hospitals, and continuity of care) favored FFS; two (length of office waits, costs of care) favored the HMO. HMO versus FFS differences in ratings of access to care and availability of resources mirror differences in the organizational features of these two systems that are generally considered responsible for the significantly lower medical expenditures at HMOs. Regardless of their origin, less favorable attitudes toward interpersonal and technical quality of care in the HMO have marked consequences: dissatisfaction and disenrollment.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. [PubMed]
  • Tessler R, Mechanic D. Factors affecting the choice between prepaid group practice and alternative insurance programs. Milbank Mem Fund Q Health Soc. 1975 Spring;53(2):149–172. [PubMed]
  • Berki SE, Ashcraft ML. HMO enrollment: who joins what and why: a review of the literature. Milbank Mem Fund Q Health Soc. 1980 Fall;58(4):588–632. [PubMed]
  • Tessler R, Mechanic D. Consumer satisfaction with prepaid group practice: a comparative study. J Health Soc Behav. 1975 Mar;16(1):95–113. [PubMed]
  • Shortell SM, Richardson WC, LoGerfo LP, Diehr P, Weaver B, Green KE. The relationships among dimensions of health services in two provider systems: a causal model approach. J Health Soc Behav. 1977 Jun;18(2):139–159. [PubMed]
  • Ashcraft M, Penchansky R, Berki SE, Fortus RS, Gray J. Expectations and experience of HMO enrollees after one year: an analysis of satisfaction, utilization, and costs. Med Care. 1978 Jan;16(1):14–32. [PubMed]
  • Gray LC. Consumer satisfaction with physician provided services: a panel study. Soc Sci Med. 1980 Jan;14A(1):65–73. [PubMed]
  • Newhouse JP, Manning WG, Morris CN, Orr LL, Duan N, Keeler EB, Leibowitz A, Marquis KH, Marquis MS, Phelps CE, et al. Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med. 1981 Dec 17;305(25):1501–1507. [PubMed]
  • Ware JE, Jr, Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Eval Program Plann. 1983;6(3-4):247–263. [PubMed]
  • Marquis MS, Davies AR, Ware JE., Jr Patient satisfaction and change in medical care provider: a longitudinal study. Med Care. 1983 Aug;21(8):821–829. [PubMed]
  • Mechanic D. The orginization of medical practice and practice orientations among physicians in prepaid and nonprepaid primary care settings. Med Care. 1975 Mar;13(3):189–204. [PubMed]
  • Wolinsky FD, Marder WD. Waiting to see the doctor. The impact of organizational structure on medical practice. Med Care. 1983 May;21(5):531–542. [PubMed]
  • Mechanic D, Weiss N, Cleary PD. The growth of HMOs: issues of enrollment and disenrollment. Med Care. 1983 Mar;21(3):338–347. [PubMed]
  • Doyle BJ, Ware JE., Jr Physician conduct and other factors that affect consumer satisfaction with medical care. J Med Educ. 1977 Oct;52(10):793–801. [PubMed]
  • Ware JE, Jr, Brook RH, Rogers WH, Keeler EB, Davies AR, Sherbourne CD, Goldberg GA, Camp P, Newhouse JP. Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care. Lancet. 1986 May 3;1(8488):1017–1022. [PubMed]
  • Ware JE, Jr, Davies AR. Behavioral consequences of consumer dissatisfaction with medical care. Eval Program Plann. 1983;6(3-4):291–297. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust