PMID: 11325324May 18, 2001Paper

Self-referral in point-of-service health plans

JAMA : the Journal of the American Medical Association
Christopher B ForrestBarbara Starfield

Abstract

Most health maintenance organizations offer products with loosened restrictions on patients' access to specialty care. One such product is the point-of-service (POS) plan, which combines "gatekeeping" arrangements with the ability to self-refer at increased out-of-pocket costs. Few data are available from formal evaluations of this new type of plan. To comprehensively describe the self-referral process in POS plans by quantifying rates of self-referral, identifying patients most likely to self-refer, characterizing patients' reasons for self-referral, and assessing satisfaction with specialty care. Retrospective cohort analysis using administrative databases composed of members aged 0 to 64 years who were enrolled in 3 POS health plans in the Midwest (n = 265 843), Northeast (n = 80 292), and mid-Atlantic (n = 39 888) regions for 6 to 12 months in 1996, and a 1997 telephone survey of specialty care users (n = 606) in the midwestern plan. Self-referred service use and charges, reasons for self-referral, and satisfaction with specialty care. Overall, 8.8% of enrollees in the midwestern POS plan, 16.7% in the northeastern plan, and 17.3% in the mid-Atlantic plan self-referred for at least 1 physician or nonphysician clinician visi...Continue Reading

Citations

Dec 13, 2005·International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services·Daniel Simonet
Mar 22, 2003·BMJ : British Medical Journal·Andrew B Bindman, Azeem Majeed
Dec 20, 2008·Journal of General Internal Medicine·Ann S O'Malley, Peter J Cunningham
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