Outcomes of patient disengagement policies: implications for managed care

The gastroenterology division at Wilford Hall Medical Center (WHMC) refers approximately 70% of outpatient consultations to civilian providers, a policy known as disengagement. This policy was implemented in the hope of reducing waiting times for appointments and testing. We conducted a telephone survey to determine whether disengaged patients eventually obtained health care and, if they did not, the reasons for this. We also attempted to determine the level of patient satisfaction with this policy. The results demonstrated that many patients did not obtain care within the 6-month follow-up period, largely because of financial considerations. Most patients were also dissatisfied with the policy and disappointed at not having obtained care at WHMC. The results of this study have important implications for Tricare, which might result in impaired access to care through out-of-pocket patient expenses related to cost-shares and membership fees.