Provider networks and primary-care signups: do they restrict the use of medical services?

✦ Synopsis

Abstract

This article analyzes the effect of gatekeeper and network restrictions on use of health‐care services using simulation‐based estimation methods. Data from the Community Tracking Survey (1996–1997) show significant evidence of selection into plans with gatekeeper and/or network restrictions. Enrollees in plans with networks of physicians have fewer office‐based visits to non‐physician medical professionals, but more emergency room visits and hospital stays. Individuals in plans that require signups with a primary‐care provider have more visits to non‐physician providers of care, more surgeries and hospital stays but substantially fewer emergency room visits. Enrollees of plans that do not pay for out‐of‐network services have more office‐based and emergency room visits, but less surgeries and hospitalizations. Copyright © 2008 John Wiley & Sons, Ltd.

Renal insufficiency and anemia are indep

Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction1,21As published material, the contents of this manuscript may not be cited, quoted, reproduced or published without the consent of the authors.2The analyses upon which this publication is based were performed under Contract Number 500-96-P704, entitled âOperation Utilization and Quality Control Peer Review Organization (PRO) for the State of Georgiaâ and sponsored by the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services. The conclusions and opinions expressed, and methods used herein are those of the authors. They do not necessarily reflect CMS policy. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this Contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.

✍ Langston, Robert D.; Presley, Rodney; Flanders, W. Dana; Mcclellan, William M. 📂 Article 📅 2003 🏛 Nature Publishing Group 🌐 English ⚖ 373 KB