Study Finds Few POS Enrollees Use Self-Referrals
While the percentage of U.S. employer-based enrollment in point-of-service health plans -- designed to give consumers greater flexibility compared to traditional HMOs -- increased from 5% in 1993 to 22% in 2000, a new study published in yesterday's Journal of the American Medical Association finds that only 4% to 7% of those in POS plans take advantage of their ability to obtain specialty care through a self-referral. Using 1996 as the study year, researchers examined the members ages 0 to 64 of three commercial POS plans -- one each in the Midwest, Northeast and mid-Atlantic. They found that 8.8%, 16.7% and 17.3% of enrolles, respectively, "self-referred for at least one physician or nonphysician clinical visit," with slightly more people self-referring to generalists than to specialists. The researchers also conducted a survey of members who used specialty care and found that "patients with chronic and orthopedic conditions, higher cost-sharing for physician-approved services and less continuity with their regular physician" were more likely to self-refer. Those who self-referred also "were more satisfied with the specialty care they received" compared to patients who were referred by a primary care physician. Still, given the overall low percentage of self-referrals, the authors of the study conclude, "Having the option to self-refer is enough for most POS plan enrollees" (Forrest et. al., JAMA, 5/2).
The study also found that enrolling in a POS last year cost families an average of $623 more compared to HMO coverage, the Sacramento Bee reports. According to Larry Levitt of the Kaiser Family Foundation, POS plans became more popular in the late 1990s due to consumer dissatisfaction with HMOs, combined with the tight labor market and booming economy. However, as the economy weakens, Levitt said that more people will have to weigh the costs of POS plans against their benefits of greater freedom and choice. "Whether the extra premiums and fees are worth it is a question we're going to hear more," he said (Rapaport, Sacramento Bee, 5/2). To read the full study go to http://jama.ama-assn.org/issues/current/rfull/joc01904.html .