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J Gen Intern Med. 1999 May;14(5):287-96.

The influence of gatekeeping and utilization review on patient satisfaction.

Author information

1
Center for Practice Management and Outcomes Research, VA Medical Center, Ann Arbor, Mich., USA.

Abstract

OBJECTIVE:

To examine the influence of utilization review and denial of specialty referrals on patient satisfaction with overall medical care, willingness to recommend one's physician group to a friend, and desire to disenroll from the health plan.

DESIGN:

Two cross-sectional questionnaires: one of physician groups and one of patient satisfaction.

SETTING:

Eighty-eight capitated physician groups in California.

PARTICIPANTS:

Participants were 11,710 patients enrolled in a large California network-model HMO in 1993 who received care in one of the 88 physician groups.

MEASUREMENTS AND MAIN RESULTS:

Our main measures were how groups conducted utilization review for specialty referrals and tests, patient-reported denial of specialty referrals, and patient satisfaction with overall medical care. Patients in groups that required preauthorization for access to many types of specialists were significantly (p </=.001) less satisfied than patients in groups that had few preauthorization requirements, even after adjusting for patient and other group characteristics. Patients who had wanted to see a specialist in the previous year but did not see one were significantly less satisfied than those who had wanted to see a specialist and actually saw one (p <.001). In addition, patients who did not see a specialist when desired were more likely to want to disenroll from the health plan than patients who saw the specialist (40% vs 18%, p </=.001) and more likely not to recommend their group to a friend (38% vs 13%, p </=.001).

CONCLUSIONS:

Policies that limited direct access to specialists, and especially denial of patient-desired referrals, were associated with significantly lower patient satisfaction, increased desire to disenroll, and lower likelihood of recommending the group to a friend. Health plans and physician groups need to take these factors into account when designing strategies to reduce specialty care use.

PMID:
10337038
PMCID:
PMC1496580
DOI:
10.1046/j.1525-1497.1999.00336.x
[Indexed for MEDLINE]
Free PMC Article

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