Determinants of primary care physicians' referral pattern: A structural equation model approach
- Authors
- Chung, K.; Yang, D.; Lee, J.H.
- Issue Date
- 2010
- Publisher
- Inderscience Publishers
- Keywords
- Managed care; Nurse practitioner; Physician assistant; Physician referral
- Citation
- International Journal of Public Policy, v.5, no.2-3, pp.259 - 271
- Indexed
- SCOPUS
- Journal Title
- International Journal of Public Policy
- Volume
- 5
- Number
- 2-3
- Start Page
- 259
- End Page
- 271
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/118342
- DOI
- 10.1504/IJPP.2010.030607
- ISSN
- 1740-0600
- Abstract
- This study examines patient referrals by primary care physicians (PCP) with nurse practitioners and physician assistants (NP-PA) in their medical practices as compared to practices without them. The study uses data from the Robert Wood Johnson Foundation community tracking study (CTS) Physician Survey, Round I (1996-97) and II (1998-99). Structural equations with binary dependent variables were used to examine the links among managed care, the use of NP-PA, the complexity of patient's conditions, and the number of referrals. PCP's with NP-PA were found to have a greater likelihood of treating patients with complex conditions instead of referring them to specialists. Managed care related variables (i.e., large group practice/HMO, the percentage of patients for whom PCPs acted as gatekeepers, and the percentage of managed care revenue from capitated/prepaid contracts) affected PCP' patient referrals, but only through the increased use of NP-PA. PCP's with NP-PA were also found to provide appropriate care to the complex patients. These findings indicate that NP-PA enable PCP to concentrate on patients with more complex conditions thus reducing the number of referrals. In addition, NP-PA is found to affect the gatekeeper role of PCPs. Copyright © 2010 Inderscience Enterprises Ltd.
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