Managed Care and the Primary-Specialty Care Interface. Abstract, ExecutiveSummary, and Final Report

摘要

This study examined how managed care influences the occurrence and content ofreferrals that primary care physicians make to specialty care. During 1997-1999 survey data were collected prospectively in the practices of 155 primary care physicians located in 31 states for samples of 37,109 office visits and 2,802 referrals. The chances of specialty referral were directly related to the proportion of managed care patients in a practice and physicians' reluctance to disclose uncertainty to patients. Referrals were less commonly made by physicians in small group practices compare with counterparts. Uninsured patients were referred less frequently than those with insurance. Primary care capitation payment increased the chances that patients were referred for discretionary indications. The effects of managed care on referral results differed between physicians and patients. Physicians reported lower satisfaction with specialty care their patients received, while the same patients reported higher levels of satisfaction with their referral experiences.