REFERRALS OF ADULT PATIENTS FROM PRIMARY-CARE - DEMOGRAPHIC DISPARITIES AND THEIR RELATIONSHIP TO HMO INSURANCE

BACKGROUND. Increasing enrollment in managed care organizations and di ssatisfaction with policies to restrict direct access to specialists h ave intensified interest in referrals from primary care physicians to specialists. We examined the associations of demographic factors and i nsurance with referrals of adult patients by primary care physicians. METHODS. Office visits of adult patients to primary care physicians (g eneral practitioners, family physicians, and internists) reported in t he National Ambulatory Care Survey for the years 1985 through 1992 wer e used to examine referrals by primary care physicians. Regression ana lyses were adjusted for patient factors (age, sex, race, insurance, ca se mix, diagnostic category, new problem or not, new patient or not, a nd visit length), physician factors (age, sex, specialty, and degree o f specialization), and practice factors (proportion of HMO patients, r ural location, region, and study year). RESULTS. Overall, 4.5% of pati ents were referred compared with 7.5% of patients with HMO insurance. After adjustment, an increased likelihood of referral was associated w ith being a male patient, having fewer medications prescribed, not bei ng seen before for the presenting problem, a longer visit, less physic ian specialization, seeing a female physician, seeing an internist, an d seeing a physician with a greater proportion of patients with HMO in surance. Among patients with HMO insurance, no gender disparity in ref erral rate was observed, and patients who also had Medicaid or Medicar e insurance were more likely to be referred. CONCLUSIONS. Male patient s are more likely to be referred. HMO insurance may reduce this gender disparity and increase the access of patients with Medicaid and Medic are to specialty care.