Health Expenditures for Privately Insured Adults Enrolled in Managed Care Gatekeeping vs Indemnity Plans

Gatekeeping arrangements, whereby health maintenance organizations mandate that primary care providers approve referrals to specialists, were the focus of the current investigation. Data from the 1996 Medical Expenditure Panel Survey (MEPS) of the Agency for Healthcare Research and Quality (AHRQ) was analyzed for a nationally representative sample of 8,195 adults who had private insurance. Gatekeeping plan enrollees were compared to indemnity plan enrollees in regard to health care expenditures.

Key Findings:

  • There were no significant differences between gatekeeping and indemnity enrollees in terms of proportion of group with inpatient expense or amount of annual inpatient expenses.
  • Gatekeeping enrollees had a higher proportion of ambulatory expenditures than did indemnity enrollees. However, the amount spent on ambulatory expenditures was not significantly different between the two groups.
  • Managed care gatekeeping enrollees paid less in out-of-pocket expenditures but more in third-party payments for ambulatory services than did indemnity enrollees.
  • Even after controlling for sociodemographic and health factors, such as gender, ethnicity and perceived health status, expenditures for gatekeeping enrollees were 6 percent lower as compared to their indemnity enrollee counterparts.