The Municipal Health Services Program. Improving access to primary care without increasing expenditures.

Under the Municipal Health Services Program (MHSP), five city governments created networks of primary care clinics with a goal of serving populations thought to have poor access to primary medical care. A major concern was fragmented care in public hospitals and other public facilities. The new MHSP clinics were expected to provide care at lower cost than the population's alternative sources of care. Medicare and Medicaid waivers were also provided. This evaluation indicates that MHSP did reach most, but not all, of the targeted groups. MHSP may have successfully replaced some outpatient department and emergency room services. However, it failed to realize the program goals of continuity and high patient satisfaction. Per capita expenditures for medical care for MHSP users were no higher than for others, but also were not significantly lower. However, for Medicare eligible MHSP users, expenditures by Medicare were significantly less.