Title: Determinants of primary care physicians' referral pattern: a structural equation model approach

Authors: Kyusuk Chung, Duckhye Yang, Jun Hyup Lee

Addresses: Department of Health Administration, College of Health and Human Services, Governors State University, University Park, IL 60466-097, USA. ' Chapin Hall Center for Children, University of Chicago, 1313 East 60th Street, Chicago, Illinois 60637, USA. ' Department of Healthcare Management, College of Health Sciences, Korea University, San 1, Jeongneung-Dong, SeongbukGu, Seoul 136-703, Korea

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.

Keywords: physician referrals; nurse practitioners; physician assistants; managed care; primary healthcare; referral patterns; structural equation modelling; primary care physicians; patient referrals.

DOI: 10.1504/IJPP.2010.030607

International Journal of Public Policy, 2010 Vol.5 No.2/3, pp.259 - 271

Published online: 26 Dec 2009 *

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