MANAGED CARE AND PHYSICIAN REFERRAL

In the era of managed care,fundamental changes are occurring in the Am erican health care system that are altering physician referral pattern s. Faced with higher premiums that erode profits and competitiveness, employers, government, and nonprofit agencies are contracting with man aged care organizations, which control costs partly by imposing constr aints and incentives on physician referral behavior. As more and more Americans are covered by managed care plans, it becomes more important to understand how managed care organizations control access to specia lists and how these controls affect health outcomes. The authors prese nt a model defining the expected influence of managed care on physicia n referral based on social exchange theory and the empirical literatur e. They conclude with a discussion of the future research implications of the model.