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  1. Gatekeeping and referral of children and adolescents to specialty care.

    Article - En anglais


    In this study we examined how gatekeeping arrangements influence referrals to specialty care for children and adolescents in private and Medicaid insurance plans.


    We conducted a prospective study of office visits (n=27104) made to 142 pediatricians in 94 practices distributed throughout 36 states in a national primary care practice-based research network.

    During 10 practice-days, physicians and patients completed questionnaires on referred patients, while office staff kept logs of all visits.

    Physicians used medical records to complete questionnaires for a subset of patients 3 months after their referral was made.


    Gatekeeping arrangements were common among children and adolescents with private (57.8%) and Medicaid (43.3%) insurance.

    Patients in gatekeeping plans were more likely to be referred with private (3.16% vs 1.85% visits referred) and Medicaid (5.39% vs 3.73%) financing.

    Increased parental requests for specialty care among gatekeeping patients did not explain the increased referral rate.

    Physicians'reasons for making the referral were similar between the two groups.

    Physicians were less likely to schedule an appointment or communicate with the specialist for referred patients in gatekeeping plans.

    However, rates of physician awareness that a specialist visit occurred and specialist communication back to pediatricians did not differ between the two groups 3 months after the referrals were made. (...)

    Mots-clés Pascal : Etats Unis, Amérique du Nord, Amérique, Filière, Soin, Soin intégré, Evaluation performance, Spécialité médicale, Enfant, Homme, Adolescent, Organisation santé, Handicap, Accessibilité, Coordination

    Mots-clés Pascal anglais : United States, North America, America, Drawing die, Care, Managed care, Performance evaluation, Medical specialty, Child, Human, Adolescent, Public health organization, Handicap, Accessibility, Coordination

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0422334

    Code Inist : 002B30A04D. Création : 22/03/2000.