Visits to Primary Care Physicians and to Specialists Under Gatekeeper and Point-of-Service Arrangements

Published in: American Journal of Managed Care, v. 6, no. 11, Nov. 2000, p. 1189-1196

Posted on RAND.org on January 01, 2000

by Geoffrey F. Joyce, Kanika Kapur, Krista A. Van Vorst, Jose J. Escarce

Read More

Access further information on this document at www.ajmc.com

This article was published outside of RAND. The full text of the article can be found at the link above.

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. STUDY DESIGN: 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 and METHODS: 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. The authors 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 FICPs and a greater number of total physician visits in the gatekeeper HMO than in the point-of-service plan. However, the authors did not observe higher rates of specialist visits in the point-of-service HMO. CONCLUSION: The authors found no evidence that direct patient access to specialists leads to higher rates of specialty visits in plans with modest cost-sharing arrangements.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.