Prepaid Group Practice and the New "Demanding Patient"

Based on an extensive field study of the practitioners in a large, prepaid service contract group practice, this paper discusses how a prepaid service contract and closed-panel practice brings a new dimension into doctorpatient relations and how physicians respond to it. Unable to manage unreasonable demands for service by use of a fee-barrier or encouragement to go elsewhere, as in traditional, solo, fee-for-service practice, they were particularly upset by a new type of demanding patient who claimed services on the basis of contractual rights and threatened appeal to higher bureaucratic authority. Modes of dealing with such patients are briefly discussed.