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

D Ansell, G Schiff, S Dick, C Cwiak and K Wright

Cook County Hospital, Chicago, Ill. 60612, USA.

OBJECTIVES: This study identified public hospital patients' preferences under managed care and health reform. METHODS: A cross-sectional survey of 348 ambulatory public hospital patients was conducted. RESULTS: 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. CONCLUSIONS: 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.