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January 5, 2000

Environmental Health

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(1):56-57. doi:10-1001/pubs.JAMA-ISSN-0098-7484-283-1-jbk0500

In Reply: Mr Barzilai and Dr Rimm propose 2 interesting and testable hypotheses: first, that physician referrals might be a major factor underlying the relationship between the 2 types of care, and second, that uninsured patients might use these therapies differently than those with health insurance do.

Table 1 shows the multivariate analysis modeling use and quantity of physician visits as a function of unconventional service use in 2 subgroups: patients not reporting a physician referral for unconventional treatment and patients without insurance. In each of these subsamples, having an unconventional visit is strongly associated with physician visits, although the magnitude of these associations is somewhat smaller than for the entire sample. These findings suggest that insurance status and physician referrals may partly mediate, but are not the primary factors driving, the association between the 2 systems of care.