Managed Care, Physician Referral and Medical Outcomes. Abstract, ExecutiveSummary, Final Report and Tables

摘要

Objective: To determine whether managed care controls were associated withreduced access to specialists and worse outcomes of care among primary care patients with pain and depressive symptoms. Methods: In a prospective cohort design, 17,187 patients were screened in the waiting rooms of 261 primary physicians in the Seattle area to identify 2,850 English-speaking adult patients with pain and/or depressive symptoms. Patients were followed for 6-months to measure referral, specialist utilization, and outcomes. The intensity of managed care was measured for health insurance plans, offices, and physicians. Multiple regression tested for associations between managed care variables, access to specialists, and outcomes. Results: Referrals and specialists utilization were common and similar in less vs. more managed plans and offices. However, for pain patients and low income depression patients, a financial withhold for referral was associated with fewer referrals. Referred depression patients had fewer referrals to psychiatrists. Health outcomes were similar in less vs. more managed settings, but patient dissatisfaction with their primary physicians was greater in more managed plans and offices. Conclusions: Managed care generally was not associated with reduced access to specialists and adverse health outcomes, but reductions in patient satisfaction with primary physicians were detected.