Hutchinson Michael, Chawluk John B, Gomez Camilo, Greenberg Jack, Hussey Francis D, Preston William G, Zimmerman Earl
NYU Langone Medical Center, New York, New York 10016, USA.
J Neuroimaging. 2009 Jan;19(1):80-3. doi: 10.1111/j.1552-6569.2008.00290.x.
For several years, some sectors of the specialty of Radiology have complained about the practice of self-referral, where a nonradiologist physician provides and interprets an imaging procedure. It is argued that such practice leads to increased costs since a physician will overutilize technology because of financial incentives. Here we review the literature. The most extensive analysis to date is at odds with the conclusions drawn in the older literature in that it provides little, if any, evidence for overutilization. We performed our own investigation using a poll study and found no suggestion of overutilization in 33 self-referring neurologists when compared with 900 neurologists who referred imaging to radiologists. The main period of growth in demand for imaging was between 1999 and 2002. Since 2002 there has been a steep decline in the rate of growth, so that it is possible to predict roughly zero growth in MRI utilization by 2009 without any intervention. It is shown why the rise in demand for imaging studies cannot be explained by self-referral, and it is argued that the sudden expansion of demand 8 years ago was caused by simultaneous technological improvements in the 3 major imaging modalities. Finally, it is shown how self-referral may actually reduce costs by facilitating the transfer of care from the hospital and ER to the office.
多年来，放射学专业的一些领域一直在抱怨自我转诊的做法，即非放射科医生提供并解读影像检查。有人认为这种做法会导致成本增加，因为医生会出于经济诱因过度使用技术。在此我们回顾相关文献。迄今为止最广泛的分析与旧文献中的结论不一致，因为它几乎没有（如果有的话）提供过度使用的证据。我们通过一项民意调查研究进行了自己的调查，发现与900名将影像检查转诊给放射科医生的神经科医生相比，33名自我转诊的神经科医生没有过度使用的迹象。影像检查需求的主要增长期在1999年至2002年之间。自2002年以来，增长率急剧下降，因此在没有任何干预的情况下，预计到2009年MRI使用率的增长大致为零。文中说明了为何影像检查需求的增长不能用自我转诊来解释，并认为8年前需求的突然增长是由三大影像模式的同步技术改进导致的。最后，文中展示了自我转诊实际上如何通过促进医疗从医院和急诊室向诊所的转移来降低成本。
