MacEachern Lillian
Issue Brief Health Policy Track Serv. 2003 Dec 31:1-25.
Consumer demand for a less restrictive referral system has urged legislators, as well as the managed care industry and those in the medical field, to seek the best solution to the problem. The point of service (POS) plan was an early attempt by managed care plans to provide more freedom for enrollees. But POS plans are not always available or cost effective. Several of the larger managed care organizations, in an effort to improve enrollee and provider satisfaction, have eliminated or streamlined their referral processes. The American Medical Association has recommended that primary care and other medical specialty organizations collaborate in developing guidelines for specialty referrals, urging health plans to allow direct access in network without financial penalty as long as the access conforms with the established guidelines. In the meantime, legislators have responded to constituents by enacting measures that mandate direct access for specific types of care or standing referrals for ongoing treatment.
消费者对限制较少的转诊系统的需求促使立法者、管理式医疗行业以及医疗领域的人士寻求该问题的最佳解决方案。服务点（POS）计划是管理式医疗计划为参保人提供更多自由的早期尝试。但POS计划并非总能提供，也不总是具有成本效益。一些较大的管理式医疗组织为提高参保人和医疗服务提供者的满意度，已经取消或简化了他们的转诊流程。美国医学协会建议初级保健和其他医学专科组织合作制定专科转诊指南，敦促健康计划允许在符合既定指南的情况下，参保人在网络内直接就诊而无需承担经济处罚。与此同时，立法者已通过制定措施来回应选民，这些措施要求为特定类型的护理提供直接就诊渠道或为持续治疗提供长期转诊。
