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

    • July 1, 2002

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.