Referral of children to specialists in the united states and the United Kingdom

Christopher B. Forrest, Azeem Majeed, Jonathan Weiner, Kevin Carroll, Andrew B. Bindman

Research output: Contribution to journalArticle

Abstract

Objective: To compare the rates and patterns of children's specialty referrals in the United States (US) and the United Kingdom (UK). Design: Retrospective cohort analysis of health care claims/encounter data obtained in 1996 (US) and 1997 (UK). Setting: Children in the US were selected from 5 managed health plans that used primary care physicians as gatekeepers: 2 health maintenance organizations and 3 point-of-service plans. Point-of-service plans allow patient self-referral at increased out-of-pocket costs. In the UK, the General Practice Research Database provided data from 211 general practices. Participants: Children, from birth to the age of 17 years, with no cost sharing for physician services in the US (n= 135092) and who were registered with general practitioners, all of whom authorize patients' access to specialty care, in the UK (n=221312). Main Outcome Measure: Annual percentage of children referred to a specialist. Results: Across the 5 US plans, 18.6% to 28.8% of the patients per year were referred vs 8.7% of the patients per year in the UK sample. Referral rates were not significantly different between a health maintenance organization and a point-of-service plan administered by a single insurer. Compared with patients in the UK sample, those in the US plans were 1.9 times more commonly referred to medical specialists and 3.2 times more commonly referred to surgical specialists. There was considerable cross-national variation in specialty-specific referral rates for children with selected conditions. Conclusions: Children in US managed care plans are between 2 and 3 times as likely to be referred to specialists compared with counterparts in the UK. Although these referral rate differences are substantial, our findings cannot be construed to mean that the US referral rates are too high or that the UK rates are too low. The greater supply of specialists and higher expectations for direct access to specialty care in the US, compared with the UK, are likely explanations for these differences in children's specialty referral rates.

Original languageEnglish (US)
Pages (from-to)279-285
Number of pages7
JournalArchives of Pediatrics and Adolescent Medicine
Volume157
Issue number3
StatePublished - Mar 1 2003

Fingerprint

Referral and Consultation
Health Maintenance Organizations
General Practice
Cost Sharing
United Kingdom
Insurance Carriers
Managed Care Programs
Primary Care Physicians
Health Expenditures
General Practitioners
Cohort Studies
Outcome Assessment (Health Care)
Parturition
Databases
Delivery of Health Care
Physicians
Health
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Referral of children to specialists in the united states and the United Kingdom. / Forrest, Christopher B.; Majeed, Azeem; Weiner, Jonathan; Carroll, Kevin; Bindman, Andrew B.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 157, No. 3, 01.03.2003, p. 279-285.

Research output: Contribution to journalArticle

Forrest, Christopher B. ; Majeed, Azeem ; Weiner, Jonathan ; Carroll, Kevin ; Bindman, Andrew B. / Referral of children to specialists in the united states and the United Kingdom. In: Archives of Pediatrics and Adolescent Medicine. 2003 ; Vol. 157, No. 3. pp. 279-285.
@article{51d739888c024357a25540cacd229ad2,
title = "Referral of children to specialists in the united states and the United Kingdom",
abstract = "Objective: To compare the rates and patterns of children's specialty referrals in the United States (US) and the United Kingdom (UK). Design: Retrospective cohort analysis of health care claims/encounter data obtained in 1996 (US) and 1997 (UK). Setting: Children in the US were selected from 5 managed health plans that used primary care physicians as gatekeepers: 2 health maintenance organizations and 3 point-of-service plans. Point-of-service plans allow patient self-referral at increased out-of-pocket costs. In the UK, the General Practice Research Database provided data from 211 general practices. Participants: Children, from birth to the age of 17 years, with no cost sharing for physician services in the US (n= 135092) and who were registered with general practitioners, all of whom authorize patients' access to specialty care, in the UK (n=221312). Main Outcome Measure: Annual percentage of children referred to a specialist. Results: Across the 5 US plans, 18.6{\%} to 28.8{\%} of the patients per year were referred vs 8.7{\%} of the patients per year in the UK sample. Referral rates were not significantly different between a health maintenance organization and a point-of-service plan administered by a single insurer. Compared with patients in the UK sample, those in the US plans were 1.9 times more commonly referred to medical specialists and 3.2 times more commonly referred to surgical specialists. There was considerable cross-national variation in specialty-specific referral rates for children with selected conditions. Conclusions: Children in US managed care plans are between 2 and 3 times as likely to be referred to specialists compared with counterparts in the UK. Although these referral rate differences are substantial, our findings cannot be construed to mean that the US referral rates are too high or that the UK rates are too low. The greater supply of specialists and higher expectations for direct access to specialty care in the US, compared with the UK, are likely explanations for these differences in children's specialty referral rates.",
author = "Forrest, {Christopher B.} and Azeem Majeed and Jonathan Weiner and Kevin Carroll and Bindman, {Andrew B.}",
year = "2003",
month = "3",
day = "1",
language = "English (US)",
volume = "157",
pages = "279--285",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Referral of children to specialists in the united states and the United Kingdom

AU - Forrest, Christopher B.

AU - Majeed, Azeem

AU - Weiner, Jonathan

AU - Carroll, Kevin

AU - Bindman, Andrew B.

PY - 2003/3/1

Y1 - 2003/3/1

N2 - Objective: To compare the rates and patterns of children's specialty referrals in the United States (US) and the United Kingdom (UK). Design: Retrospective cohort analysis of health care claims/encounter data obtained in 1996 (US) and 1997 (UK). Setting: Children in the US were selected from 5 managed health plans that used primary care physicians as gatekeepers: 2 health maintenance organizations and 3 point-of-service plans. Point-of-service plans allow patient self-referral at increased out-of-pocket costs. In the UK, the General Practice Research Database provided data from 211 general practices. Participants: Children, from birth to the age of 17 years, with no cost sharing for physician services in the US (n= 135092) and who were registered with general practitioners, all of whom authorize patients' access to specialty care, in the UK (n=221312). Main Outcome Measure: Annual percentage of children referred to a specialist. Results: Across the 5 US plans, 18.6% to 28.8% of the patients per year were referred vs 8.7% of the patients per year in the UK sample. Referral rates were not significantly different between a health maintenance organization and a point-of-service plan administered by a single insurer. Compared with patients in the UK sample, those in the US plans were 1.9 times more commonly referred to medical specialists and 3.2 times more commonly referred to surgical specialists. There was considerable cross-national variation in specialty-specific referral rates for children with selected conditions. Conclusions: Children in US managed care plans are between 2 and 3 times as likely to be referred to specialists compared with counterparts in the UK. Although these referral rate differences are substantial, our findings cannot be construed to mean that the US referral rates are too high or that the UK rates are too low. The greater supply of specialists and higher expectations for direct access to specialty care in the US, compared with the UK, are likely explanations for these differences in children's specialty referral rates.

AB - Objective: To compare the rates and patterns of children's specialty referrals in the United States (US) and the United Kingdom (UK). Design: Retrospective cohort analysis of health care claims/encounter data obtained in 1996 (US) and 1997 (UK). Setting: Children in the US were selected from 5 managed health plans that used primary care physicians as gatekeepers: 2 health maintenance organizations and 3 point-of-service plans. Point-of-service plans allow patient self-referral at increased out-of-pocket costs. In the UK, the General Practice Research Database provided data from 211 general practices. Participants: Children, from birth to the age of 17 years, with no cost sharing for physician services in the US (n= 135092) and who were registered with general practitioners, all of whom authorize patients' access to specialty care, in the UK (n=221312). Main Outcome Measure: Annual percentage of children referred to a specialist. Results: Across the 5 US plans, 18.6% to 28.8% of the patients per year were referred vs 8.7% of the patients per year in the UK sample. Referral rates were not significantly different between a health maintenance organization and a point-of-service plan administered by a single insurer. Compared with patients in the UK sample, those in the US plans were 1.9 times more commonly referred to medical specialists and 3.2 times more commonly referred to surgical specialists. There was considerable cross-national variation in specialty-specific referral rates for children with selected conditions. Conclusions: Children in US managed care plans are between 2 and 3 times as likely to be referred to specialists compared with counterparts in the UK. Although these referral rate differences are substantial, our findings cannot be construed to mean that the US referral rates are too high or that the UK rates are too low. The greater supply of specialists and higher expectations for direct access to specialty care in the US, compared with the UK, are likely explanations for these differences in children's specialty referral rates.

UR - http://www.scopus.com/inward/record.url?scp=0037345554&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037345554&partnerID=8YFLogxK

M3 - Article

C2 - 12622678

AN - SCOPUS:0037345554

VL - 157

SP - 279

EP - 285

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 3

ER -