Assessing Medicaid patients' perceptions of the OB/GYN-patient relationship

OBJECTIVES: The objective of this study was to understand how the dynamics of the health care provider-patient relationship differ between Medicaid patients and private pay patients in the context of obstetric care. Various aspects of the patient-physician relationship were examined including trust, commitment, dependence, social content, service quality, and behavioral outcomes such as satisfaction, referral behavior, ease of voice, and retention. METHODS: Questionnaires were mailed to a sample of mothers who had recently given birth. MANOVA was used to compare the means of Medicaid patients with private pay patients for the variables of interest in the study. RESULTS: Medicaid patients had lower commitment to their primary physician. They trusted the practice, the primary physician, and the other physicians in the practice less. They perceived themselves as less similar to both the overall practice and their primary physician and also rated their health care service experience lower. They were less satisfied and less likely to use the same practice for future pregnancies or make referrals. They also felt less comfortable voicing complaints. CONCLUSIONS: The evidence clearly indicates that Medicaid obstetric patients perceived their service experience more negatively than private pay patients. Health care providers know they must provide clinical quality for their patients, however, in treating Medicaid patients they need to focus on patient driven-quality as well. The results indicate that health care providers, particularly OB/GYNs, need to do a better job of determining and delivering the key performance criteria that Medicaid patients use to make trust judgements.