Visits to primary care physicians and to specialists under gatekeeper and point-of-service arrangements.
Am J Manag Care
; 6(11): 1189-96, 2000 Nov.
Article
in En
| MEDLINE
| ID: mdl-11185844
ABSTRACT
OBJECTIVE:
To assess utilization of ambulatory visits to primary care physicians (PCPs) and to specialists in 2 different managed care models a closed panel gatekeeper health maintenance organization (HMO) and an open panel point-of-service HMO. STUDYDESIGN:
Retrospective study of patients enrolled in a single managed care organization with 2 distinct product lines a gatekeeper HMO and a point-of-service HMO. Both plans shared the same physician network. PATIENTS ANDMETHODS:
The study sample included 16,192 working-age members of the gatekeeper HMO and 36,819 working-age members of the point-of-service HMO. We estimated the number of PCP and specialist visits using negative binomial regression models and predicted the number of visits per year for each person under each HMO type and copayment option.RESULTS:
There were more annual visits to PCPs and a greater number of total physician visits in the gatekeeper HMO than in the point-of-service plan. However, we did not observe higher rates of specialist visits in the point-of-service HMO.CONCLUSION:
We found no evidence that direct patient access to specialists leads to higher rates of specialty visits in plans with modest cost-sharing arrangements.
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Collection:
01-internacional
Health context:
2_ODS3
Database:
MEDLINE
Main subject:
Primary Health Care
/
Specialization
/
Health Maintenance Organizations
/
Gatekeeping
/
Health Services Accessibility
/
Medicine
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Determinantes_sociais_saude
Limits:
Adolescent
/
Adult
/
Humans
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Am J Manag Care
Year:
2000
Document type:
Article