Résumé :
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[BDSP. Notice produite par INIST eR0x1ZMQ. Diffusion soumise à autorisation]. Context Most health maintenance organizations offer products with loosened restrictions on patients'access to specialty care. One such product is the point-of-service (POS) plan, which combines "gatekeeping" arrangements with the ability to self-refer at increased out-of-pocket costs. Few data are available from formal evaluations of this new type of plan. Objectives To comprehensively describe the self-referral process in POS plans by quantifying rates of self-referral, identifying patients most likely to self-refer, characterizing patients'reasons for self-referral, and assessing satisfaction with specialty care. Design Retrospective cohort analysis using administrative databases composed of members aged 0 to 64 years who were enrolled in 3 POS health plans in the Midwest (n=265 843), Northeast (n=80292), and mid-Atlantic (n=39 888) regions for 6 to 12 months in 1996, and a 1997 telephone survey of specialty care users (n=606) in the midwestern plan. Main Outcome Measures Self-referred service use and charges, reasons for self-referral, and satisfaction with specialty care. Results Overall, 8.8% of enrollees in the midwestern POS plan, 16.7% in the north-eastern plan, and 17.3% in the mid-Atlantic plan self-referred for at least 1 physician or nonphysician clinician visit. The proportions of enrollees self-referring to generalists (4.7% - 8.5%) were slightly higher than the proportions self-referring to specialists (3.7% - 7.2%) across all 3 plans. (...)
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