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August 8, 2001

Factors Affecting Patients' Self-referral to Specialists—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(6):672-673. doi:10.1001/jama.286.6.672

In Reply: We agree with Dr Hsu and colleagues that many patients appear to view the POS option for self-referral as a way to ensure their choice of practitioners, even though most will not avail themselves of this option. Among patients in our study who saw a specialist, 1 of 120 visited an out-of-network specialist in a Blue Cross/Blue Shield plan with very high statewide provider participation. In another plan, physician participation was limited to a metropolitan area, and 1 of 16 patients who had a specialty referral had an out-of-network specialist visit. Physician participation within a health plan's market area is probably a strong determinant of rates of out-of-plan use.

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