Health care and the poor: psychological implications of restrictive policies

Medicaid proposals increasingly focus on cost-saving strategies that restrict clients' control over where and when they may receive services. This study used a field experiment in an urban welfare office to examine the possible effects of two aspects of restrictive policies: the loss of choice of providers and adverse patient mix (i.e., when the majority of a provider's clients are Medicaid beneficiaries). Results indicate that health care presented within the context of not having a choice is derogated and that choice and patient mix combine to influence intentions to seek care. Persons who did not choose the health plan in a simulated choice, who had fewer choices than expected, and who did not accept restricted choice also had negative perceptions.