Is There a Specialist in the House? Most People Don't Ask the Question

Researchers from the Johns Hopkins University School of Hygiene and Public Health examined the mix of services provided to consumers enrolled in alternative types of managed-care plans.

They looked specifically at the point-of-service (POS) model, which gives enrollees the option to seek covered services from non-network providers.

The project was part of the Robert Wood Johnson Foundation (RWJF) national program Generalist Provider Research Initiative.

Key Findings

  • In an article in the Journal of the American Medical Association and a series of reports, the investigators highlighted the following findings:

    • Relatively small numbers of enrollees in POS models exercised their self-referral options—a key feature of POS plans.
    • Self-referral was related to several factors:
      • Size of the provider.
      • Presence of chronic disease.
      • Belief that the individual rather than the physician is responsible for arranging care.
      • Low level of satisfaction with the quality of specialists in the network.
      • Poor relationships with network primary care physicians.
    • Expenditures in POS plans were equivalent to those in other HMO plans but significantly lower than with those in fee-for-service models.