Expenditures for physician services under alternative models of managed care

This study compares expenditures for physician services in a closed panel g atekeeper health maintenance organization (HMO) and an open panel point of service HMO that share the same physician network. The study uses administr ative files of the two study HMOs for 1994-1995 to assess differences in sp ending for primary care physicians' (PCPs') services, specialists' services , and total physician services. When the copayments for PCP visits and PCP- referred specialist visits were $0, total physician expenditures were 4 per cent higher in the gatekeeper HMO than in the point of service plan (p < .0 5). When the copayments for PCP visits and PCP-referred specialist visits w ere $10, total physician expenditures ranged from equal in both HMOs to 7 p ercent higher in the gatekeeper HMO (p < .01), depending on the copayment f or self-referred visits. Expenditures for specialists' services were not hi gher in the point of service plan. The authors conclude that direct patient access to specialists does not necessarily result in higher physician or s pecialist expenditures in HMOs.