Comparisons of prepaid, Medicaid and fee-for-service patients using the Marshfield Clinic and affiliated non-Clinic physicians indicate that a well-organized multispecialty group can successfully provide accessible and responsive care to rural populations and integrate varying types of payment systems. Most patients were highly satisfied, but differences in satisfaction among varying subgroups were substantially attributable to access barriers. Patients in the Greater Marshfield Community Health Plan (prepaied patients) were most generally satisfied, but patients using non-Clinic affiliates were higher on socioemotional satisfaction, reflecting certain barriers to personal care in complex organizational settings.