Managed health plan effects on the specialty referral process: results from the ambulatory sentinel practice network referral study. (Health Care Industry).

"The specialty referral process is one of the chief targets of managed care constraints on ambulatory medical decision-making. [Our] study examines the influence of gatekeeping arrangements and capitated primary care physician (PCP) payment on the specialty referral process in primary care settings.

Visits were grouped by health plan type: gatekeeping with capitated PCP payment; gatekeeping with fee-for-service PCP payment; no gatekeeping. Dependent measures included the proportion of visits referred, characteristics of referrals and physician coordination activities.

The percentages of office visits resulting in referral were similar between the two …