Referrals of adult patients from primary care

Demographic disparities and their relationship to HMO insurance

Peter Franks, Carolyn M. Clancy

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

BACKGROUND. Increasing enrollment in managed care organizations and dissatisfaction with policies to restrict direct access to specialists have intensified interest in referrals from primary care physicians to specialists. We examined the associations of demographic factors and insurance with referrals of adult patients by primary care physicians. METHODS. Office visits of adult patients to primary care physicians (general practitioners, family physicians, and internists) reported in the National Ambulatory Care Survey for the years 1985 through 1992 were used to examine referrals by primary care physicians. Regression analyses were adjusted for patient factors (age, sex, race, insurance, case mix, diagnostic category, new problem or not, new patient or not, and visit length), physician factors (age, sex, specialty, and degree of specialization), and practice factors (proportion of HMO patients, rural location, region, and study year). RESULTS. Overall, 4.5% of patients were referred compared with 7.5% of patients with HMO insurance. After adjustment, an increased likelihood of referral was associated with being a male patient, having fewer medications prescribed, not being seen before for the presenting problem, a longer visit, less physician specialization, seeing a female physician, seeing an internist, and seeing a physician with a greater proportion of patients with HMO insurance. Among patients with HMO insurance, no gender disparity in referral rate was observed, and patients who also had Medicaid or Medicare insurance were more likely to be referred. CONCLUSIONS. Mate patients are more likely to be referred. HMO insurance may reduce this gender disparity and increase the access of patients with Medicaid and Medicare to specialty care.

Original languageEnglish (US)
Pages (from-to)47-53
Number of pages7
JournalJournal of Family Practice
Volume45
Issue number1
StatePublished - Jul 1997
Externally publishedYes

Fingerprint

Health Maintenance Organizations
Insurance
Primary Health Care
Patient Care
Referral and Consultation
Demography
Primary Care Physicians
Physicians
Sex Factors
Age Factors
Medicaid
Medicare
Office Visits
Diagnosis-Related Groups
Family Physicians
Managed Care Programs
Ambulatory Care
General Practitioners
Regression Analysis
Organizations

Keywords

  • Insurance, health
  • Managed care programs
  • Medicaid
  • Medicare
  • Primary health care
  • Referral and consultation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Referrals of adult patients from primary care : Demographic disparities and their relationship to HMO insurance. / Franks, Peter; Clancy, Carolyn M.

In: Journal of Family Practice, Vol. 45, No. 1, 07.1997, p. 47-53.

Research output: Contribution to journalArticle

@article{136f313061144daeb5edc5e16808b9c9,
title = "Referrals of adult patients from primary care: Demographic disparities and their relationship to HMO insurance",
abstract = "BACKGROUND. Increasing enrollment in managed care organizations and dissatisfaction with policies to restrict direct access to specialists have intensified interest in referrals from primary care physicians to specialists. We examined the associations of demographic factors and insurance with referrals of adult patients by primary care physicians. METHODS. Office visits of adult patients to primary care physicians (general practitioners, family physicians, and internists) reported in the National Ambulatory Care Survey for the years 1985 through 1992 were used to examine referrals by primary care physicians. Regression analyses were adjusted for patient factors (age, sex, race, insurance, case mix, diagnostic category, new problem or not, new patient or not, and visit length), physician factors (age, sex, specialty, and degree of specialization), and practice factors (proportion of HMO patients, rural location, region, and study year). RESULTS. Overall, 4.5{\%} of patients were referred compared with 7.5{\%} of patients with HMO insurance. After adjustment, an increased likelihood of referral was associated with being a male patient, having fewer medications prescribed, not being seen before for the presenting problem, a longer visit, less physician specialization, seeing a female physician, seeing an internist, and seeing a physician with a greater proportion of patients with HMO insurance. Among patients with HMO insurance, no gender disparity in referral rate was observed, and patients who also had Medicaid or Medicare insurance were more likely to be referred. CONCLUSIONS. Mate patients are more likely to be referred. HMO insurance may reduce this gender disparity and increase the access of patients with Medicaid and Medicare to specialty care.",
keywords = "Insurance, health, Managed care programs, Medicaid, Medicare, Primary health care, Referral and consultation",
author = "Peter Franks and Clancy, {Carolyn M.}",
year = "1997",
month = "7",
language = "English (US)",
volume = "45",
pages = "47--53",
journal = "Journal of Family Practice",
issn = "0094-3509",
publisher = "Appleton-Century-Crofts",
number = "1",

}

TY - JOUR

T1 - Referrals of adult patients from primary care

T2 - Demographic disparities and their relationship to HMO insurance

AU - Franks, Peter

AU - Clancy, Carolyn M.

PY - 1997/7

Y1 - 1997/7

N2 - BACKGROUND. Increasing enrollment in managed care organizations and dissatisfaction with policies to restrict direct access to specialists have intensified interest in referrals from primary care physicians to specialists. We examined the associations of demographic factors and insurance with referrals of adult patients by primary care physicians. METHODS. Office visits of adult patients to primary care physicians (general practitioners, family physicians, and internists) reported in the National Ambulatory Care Survey for the years 1985 through 1992 were used to examine referrals by primary care physicians. Regression analyses were adjusted for patient factors (age, sex, race, insurance, case mix, diagnostic category, new problem or not, new patient or not, and visit length), physician factors (age, sex, specialty, and degree of specialization), and practice factors (proportion of HMO patients, rural location, region, and study year). RESULTS. Overall, 4.5% of patients were referred compared with 7.5% of patients with HMO insurance. After adjustment, an increased likelihood of referral was associated with being a male patient, having fewer medications prescribed, not being seen before for the presenting problem, a longer visit, less physician specialization, seeing a female physician, seeing an internist, and seeing a physician with a greater proportion of patients with HMO insurance. Among patients with HMO insurance, no gender disparity in referral rate was observed, and patients who also had Medicaid or Medicare insurance were more likely to be referred. CONCLUSIONS. Mate patients are more likely to be referred. HMO insurance may reduce this gender disparity and increase the access of patients with Medicaid and Medicare to specialty care.

AB - BACKGROUND. Increasing enrollment in managed care organizations and dissatisfaction with policies to restrict direct access to specialists have intensified interest in referrals from primary care physicians to specialists. We examined the associations of demographic factors and insurance with referrals of adult patients by primary care physicians. METHODS. Office visits of adult patients to primary care physicians (general practitioners, family physicians, and internists) reported in the National Ambulatory Care Survey for the years 1985 through 1992 were used to examine referrals by primary care physicians. Regression analyses were adjusted for patient factors (age, sex, race, insurance, case mix, diagnostic category, new problem or not, new patient or not, and visit length), physician factors (age, sex, specialty, and degree of specialization), and practice factors (proportion of HMO patients, rural location, region, and study year). RESULTS. Overall, 4.5% of patients were referred compared with 7.5% of patients with HMO insurance. After adjustment, an increased likelihood of referral was associated with being a male patient, having fewer medications prescribed, not being seen before for the presenting problem, a longer visit, less physician specialization, seeing a female physician, seeing an internist, and seeing a physician with a greater proportion of patients with HMO insurance. Among patients with HMO insurance, no gender disparity in referral rate was observed, and patients who also had Medicaid or Medicare insurance were more likely to be referred. CONCLUSIONS. Mate patients are more likely to be referred. HMO insurance may reduce this gender disparity and increase the access of patients with Medicaid and Medicare to specialty care.

KW - Insurance, health

KW - Managed care programs

KW - Medicaid

KW - Medicare

KW - Primary health care

KW - Referral and consultation

UR - http://www.scopus.com/inward/record.url?scp=0030800278&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030800278&partnerID=8YFLogxK

M3 - Article

VL - 45

SP - 47

EP - 53

JO - Journal of Family Practice

JF - Journal of Family Practice

SN - 0094-3509

IS - 1

ER -