DO SPECIALISTS ORDER TOO MANY TESTS - THE CASE OF ALLERGISTS AND PEDIATRIC ASTHMA

Background: Is the practice style of specialists overly reliant on dia gnostic tests? Health maintenance organization managers and other clin icians have been critical of the high cost practice styles of speciali sts, but if the specialists' practice style ultimately results in simi lar or lower total costs because of better outcomes in the treatment o f exceptional cases, then such practice styles are cost-effective and should be encouraged. Indeed, if this is the case, not employing a tes t-intensive practice style could be considered negligent under a legal criterion. Objective: We attempted to determine whether the care of p ediatric asthmatic patients by allergists is characterized by more tes ting, but by better, less costly outcomes than care by non-allergists. Methods: We used administrative data on pediatric asthmatic cases fro m a large health care plan from 1992 to determine whether patients tre ated by allergists received more tests, cost more, and had fewer asthm atic management breakdowns than patients treated by non-allergists. We used regression analysis to hold constant aspects of the patient's ca se mix. Results: Although allergists ordered significantly more tests than non-allergists, their overall treatment costs were similar. Patie nts treated by allergists had fewer management breakdowns. Conclusions : These results suggest that the allergists' test-intensive practice s tyle is cost-effective.