Majority of patients in point-of-service health plans never use self-referral option for spec...( A rapidly growing trend in health ins...),Health

A rapidly growing trend in health insurance is the point-of-service (POS) plan, which allows members to seek specialty services for a fee without first consulting with their primary care physician, or plan "gatekeeper." However, the majority of patients enrolled in POS plans never use their self-referral option, according to a study by researchers at the Johns Hopkins University Bloomberg School of Public Health. In addition, the few patients who did self-refer reported being more satisfied with their specialist than patients who were referred to a specialist by their physician.

The study is the largest and most comprehensive analysis of POS health insurance plans in the United States. The findings, which appear in the May 2, 2001 issue of the Journal of the American Medical Association (JAMA), suggest that the self-referral option for patients does not lead to uncontrolled use of specialty health services as many managed care companies once feared.

"One of the greatest sources of consumer dissatisfaction with todays health maintenance organizations (HMO) is the perceived barrier to specialist care. Simply having the option to bypass the so-called gatekeepers of managed care seems to be enough for most people in point-of-service health plans," says Christopher Forrest, MD, PhD, lead author of the study and associate professor of health policy and management at the Bloomberg School of Public Health.

The POS plan, or open-HMO, is a combination of the traditional HMO, preferred provider network, and fee-for-service plans. POS plan members pay minimum fees for service within the network and for referrals authorized by the physician "gatekeeper." The members share of the cost increases for treatment outside the network and for self-referrals. According to the study, a family POS plan costs employers and workers an additional $635 per year compared to a traditional HMO.

For the study, the researchers analyzed data from three POS health plans which were lo
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Contact: Tim Parsons or Ming Tai
paffairs@jhsph.edu
410-955-6878
Johns Hopkins University Bloomberg School of Public Health
30-Apr-2001