Mothers' satisfaction with the cost of children's care: The role of practice settings and actual expenses

This paper analyses mothers' satisfaction with the cost of children's care in six widely-varying ambulatory settings: fee-for-service solo and group practices, a prepaid group, public clinics, hospital outpatient departments, and an emergency room. Data are from a household survey in Washington, DC and represent 638 children. Findings indicate significantly higher satisfaction with cost in public clinics than in solo practice, fee-for-service groups, and the emergency room, adjusting for patient characteristics, attitudes and financial coverage. In fee-for-service settings, both provider charges and out-of-pocket costs had a nonlinear relation to satisfaction with cost; to a point, increasing costs and charges were associated with decreasing satisfaction, but thereafter higher costs and charges appeared to lead, other things equal, to higher satisfaction. Out-of-pocket costs had a significantly greater negative effect on poor mothers' satisfaction than on the more affluent. Implications for current policy trends are discussed.