Which enrollees bypass their gatekeepers in a point-of-service plan?

Barbara L. Braun, Jinnet Briggs Fowles, Christopher B. Forrest, Elizabeth A. Kind, Steven S. Foldes, Jonathan Weiner

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES. Like Health Maintenance Organizations, point-of-service (POS) health plans use primary care gatekeepers, and they permit self-referral to specialists at increased costs to the enrollee. The main objective of this study was to contrast patients who self-referred with those referred by their primary care physician. RESEARCH DESIGN. We conducted a crosssectional telephone survey of 606 recent users of specialists in a large Midwestern POS health plan; response rate was 65%. We compared 148 enrollees who self-referred with 458 who had a physician referral. RESULTS. Self-referral was most common among those with a long-term relationship with a specialist (odds ratio [OR] = 2.08) and those dissatisfied with their primary care physician (OR = 3.65), and was rare among those with a long-standing relationship with a primary care physician (OR = 0.46). Most self-referred enrollees (68%) thought paying the additional cost for self-referral was worth-while, and they were more dissatisfied with the quality and variety of the plan's specialist network. CONCLUSIONS. Continuity with a single physician influences how patients access specialty care. Expanding the panel of specialists in-network and encouraging long-term relationships with primary care physicians are likely to limit self-referral in a POS plan.

Original languageEnglish (US)
Pages (from-to)836-841
Number of pages6
JournalMedical Care
Volume41
Issue number7
DOIs
StatePublished - Jul 2003
Externally publishedYes

Fingerprint

gatekeeper
Primary Care Physicians
Referral and Consultation
physician
Odds Ratio
Health Services
health service
Physicians
Costs and Cost Analysis
Health Maintenance Organizations
Telephone
costs
Primary Health Care
telephone
continuity
health

Keywords

  • Point-of-service
  • Primary care
  • Self-referral

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Braun, B. L., Fowles, J. B., Forrest, C. B., Kind, E. A., Foldes, S. S., & Weiner, J. (2003). Which enrollees bypass their gatekeepers in a point-of-service plan? Medical Care, 41(7), 836-841. https://doi.org/10.1097/00005650-200307000-00007

Which enrollees bypass their gatekeepers in a point-of-service plan? / Braun, Barbara L.; Fowles, Jinnet Briggs; Forrest, Christopher B.; Kind, Elizabeth A.; Foldes, Steven S.; Weiner, Jonathan.

In: Medical Care, Vol. 41, No. 7, 07.2003, p. 836-841.

Research output: Contribution to journalArticle

Braun, BL, Fowles, JB, Forrest, CB, Kind, EA, Foldes, SS & Weiner, J 2003, 'Which enrollees bypass their gatekeepers in a point-of-service plan?', Medical Care, vol. 41, no. 7, pp. 836-841. https://doi.org/10.1097/00005650-200307000-00007
Braun, Barbara L. ; Fowles, Jinnet Briggs ; Forrest, Christopher B. ; Kind, Elizabeth A. ; Foldes, Steven S. ; Weiner, Jonathan. / Which enrollees bypass their gatekeepers in a point-of-service plan?. In: Medical Care. 2003 ; Vol. 41, No. 7. pp. 836-841.
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