Braun Barbara L, Fowles Jinnet Briggs, Forrest Christopher B, Kind Elizabeth A, Foldes Steven S, Weiner Jonathan P
Health Research Center, Park Nicollet Institute, St. Louis Park, Minnesota 55416, USA.
Med Care. 2003 Jul;41(7):836-41. doi: 10.1097/00005650-200307000-00007.
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.
We conducted a cross-sectional 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.
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 worthwhile, and they were more dissatisfied with the quality and variety of the plan's specialist network.
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.
与健康维护组织一样，服务点（POS）健康计划采用初级保健守门人制度，并且允许参保人自行转诊至专科医生，但参保人需支付更高费用。本研究的主要目的是对比自行转诊的患者与由初级保健医生转诊的患者。
我们对中西部一个大型POS健康计划中606名近期的专科医生使用者进行了横断面电话调查；回复率为65%。我们将148名自行转诊的参保人与458名有医生转诊的参保人进行了比较。
自行转诊在与专科医生有长期关系的人群中最为常见（优势比[OR]=2.08），在对初级保健医生不满意的人群中也较为常见（OR=3.65），而在与初级保健医生有长期关系的人群中则很少见（OR=0.46）。大多数自行转诊的参保人（68%）认为为自行转诊支付额外费用是值得的，并且他们对该计划专科医生网络的质量和多样性更不满意。
与单一医生保持连续性会影响患者获得专科护理的方式。扩大网络内专科医生队伍并鼓励与初级保健医生建立长期关系，可能会限制POS计划中的自行转诊情况。
