March 10, 2003
Managed care plans generally refer patients with pain symptoms to specialists
Primary care physicians under a managed care system were more likely to refer patients to a pain specialist than other physicians were, according to a University of Washington study.
The findings run contrary to common beliefs that managed care systems limit access to specialists in order to save money. But if that was true before, it is not true now, according to the findings, which are being published in the February issue of Health Services Research.
“Managed care systems, more often than not, are giving patients the green light to see specialists,” said Dr. David Grembowski, professor of health services in the UW School of Public Health and Community Medicine. “Other recent studies also are reporting that gatekeeping and managed care are associated with more referrals to specialists.”
“It may be surprising that – at least for pain and for depression – patients in managed care generally had access to specialists and had treatment results equal to those of patients with other types of insurance. Nonetheless, managed care patients were sometimes less satisfied with their primary care, perhaps because they didn’t like having to get approval for specialty care, or having a restricted choice of specialists,” said Dr. Richard Deyo, UW professor of medicine and health services.
Up to 65 percent of primary care patients report at least some pain, according to previous studies. Almost 80 million Americans report chronic pain.
The sample in this study included 2,275 patients interviewed in the offices of 261 primary care doctors in Seattle. All of those patients reported at least one of eight categories of pain symptoms.
To conduct the study, researchers had to set up a scale that would reflect the growing complexity of managed health care. They had to consider different permutations of managed care, fee for service, and health maintenance organizations and preferred-provider organizations. Researchers had to scrutinize hundreds of different health plans in order to rank the insurance plans and primary-care offices on a 1-to-100 ‘managed care’ scale, from least restrictive to most.
The researchers used a similar methodology to study what happened to patients with symptoms of depression; those findings were published in April 2002. In that study, the researchers also found that managed care did not seem to curb access to specialists, although depressed patients in more managed health plans were less likely to see psychiatrists.
“These patterns may exist because the more highly managed offices often require patients to see their primary care physicians first before they can see a specialist, which can generate more referrals,” Grembowski said. “Also, the more highly managed offices were often in multispecialty delivery systems, and primary care physicians may be relatively free to refer to specialists inside — but not outside — their systems. As a result, patients in managed care systems were just as likely to actually see specialists for their pain as patients in less-managed health plans and medical offices.”
The study did report that just as with the April study, doctors who got more money for referring fewer people to specialists did indeed refer fewer people.
For more information about the previous study involving patients with depressive symptoms, see http://www.washington.edu/newsroom/news/2002archive/04-02archive/k041202.html
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