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 language | English (US) |
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Pages (from-to) | 836-841 |
Number of pages | 6 |
Journal | Medical care |
Volume | 41 |
Issue number | 7 |
DOIs | |
State | Published - Jul 1 2003 |
Externally published | Yes |
Keywords
- Point-of-service
- Primary care
- Self-referral
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health