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The influence of gatekeeping and utilization review on patient satisfaction
E A Kerr1, R D Hays, A Mitchinson
1Center for Practice Management and Outcomes Research, VA Medical Center, Ann Arbor, Mich., USA.
Objective:
To examine the influence of utilization review and denial of specialty referrals on patient satisfaction with overall medical care, willingness to recommend one's physician group to a friend, and desire to disenroll from the health plan.
Design:
Two cross-sectional questionnaires: one of physician groups and one of patient satisfaction.
Setting:
Eighty-eight capitated physician groups in California.
Participants:
Participants were 11,710 patients enrolled in a large California network-model HMO in 1993 who received care in one of the 88 physician groups.
Measurements And Main Results:
Our main measures were how groups conducted utilization review for specialty referrals and tests, patient-reported denial of specialty referrals, and patient satisfaction with overall medical care. Patients in groups that required preauthorization for access to many types of specialists were significantly (p
Conclusions:
Policies that limited direct access to specialists, and especially denial of patient-desired referrals, were associated with significantly lower patient satisfaction, increased desire to disenroll, and lower likelihood of recommending the group to a friend. Health plans and physician groups need to take these factors into account when designing strategies to reduce specialty care use.