Mitchell J M, de Lissovoy G
Graduate Public Policy Program, Georgetown University, Washington, DC 20007, USA.
Phys Ther. 1997 Jan;77(1):10-8. doi: 10.1093/ptj/77.1.10.
Access to physical therapy in many states is contingent on prescription or referral by a physician. Other states have enacted direct access legislation enabling consumers to obtain physical therapy without a physician referral. Critics of direct access cite potential overutilization of services, increased costs, and inappropriate care.
Using paid claims data for the period 1989 to 1993 from Blue Cross-Blue Shield of Maryland, a direct access state, we compiled episodes of physical therapy for acute musculoskeletal disorders and categorized them as direct access (n = 252) or physician referral (n = 353) using algorithms devised by a clinician advisory panel. Relative to physician referral episodes, direct access episodes encompassed fewer numbers of services (7.6 versus 12.2 physical therapy office visits) and substantially less cost ($1,004 versus $2,236).
Direct access episodes were shorter, encompassed fewer numbers of services, and were less costly than those classified as physician referral episodes. There are several potential reasons why this may be the case, such as lower severity of the patient's condition, overutilization of services by physicians, and underutilization of services by physical therapists. Concern that direct access will result in overutilization of services or will increase costs appears to be unwarranted.
在许多州，接受物理治疗取决于医生的处方或转诊。其他州已颁布直接就诊立法，使消费者无需医生转诊即可接受物理治疗。直接就诊的批评者指出，可能存在服务过度使用、成本增加以及护理不当的问题。
利用来自直接就诊州马里兰州蓝十字蓝盾公司1989年至1993年期间的付费理赔数据，我们整理了急性肌肉骨骼疾病的物理治疗病例，并使用临床医生咨询小组设计的算法将其分类为直接就诊（n = 252）或医生转诊（n = 353）。与医生转诊病例相比，直接就诊病例的服务次数较少（物理治疗门诊就诊次数分别为7.6次和12.2次），成本也大幅降低（分别为1,004美元和2,236美元）。
直接就诊病例比分类为医生转诊的病例疗程更短、服务次数更少且成本更低。出现这种情况可能有几个潜在原因，比如患者病情较轻、医生过度使用服务以及物理治疗师服务利用不足。认为直接就诊会导致服务过度使用或成本增加的担忧似乎没有根据。
