Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
Copyright 2001 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2001
To the Editor: In their study of the patterns
of self-referral by patients in point-of-service (POS) health plans, Dr Forrest
and colleagues1 noted that the number of
out-of-plan self-referrals was extremely low—between 0.2% and 1.8% of
enrollees. In the 2 Blue Cross/Blue Shield plans that they examined, this
likely reflected market conditions in which nearly all physicians in the geographic
area were enrolled in the plans, but the rate was also quite low in the plan
with the smaller network. From either an economic or a care coordination perspective,
health plans may be relatively indifferent to the self-referrals to within-plan
providers. Most of the theoretical value of POS plans to consumers and most
of the potential costs of POS plans to insurers apply to out-of-plan referrals.
While the limited number of out-of-plan visits may prevent further analyses
in this dataset, future studies on the patient and market predictors of out-of-plan
resource use would be extremely valuable in understanding the benefits and
costs associated with POS health plans.
Hsu J, Go AS, Selby J. Factors Affecting Patients' Self-referral to Specialists. JAMA. 2001;286(6):672-673. doi:10.1001/jama.286.6.672