title: The influence of gatekeeping and utilization review on patient satisfaction.
abstract: 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.
  
  
  METHODS
  Two cross-sectional questionnaires: one of physician groups and one of patient satisfaction.
  
  
  METHODS
  Eighty-eight capitated physician groups in California.
  
  
  METHODS
  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.
  
  
  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 </=.001) less satisfied than patients in groups that had few preauthorization requirements, even after adjusting for patient and other group characteristics. Patients who had wanted to see a specialist in the previous year but did not see one were significantly less satisfied than those who had wanted to see a specialist and actually saw one (p <.001). In addition, patients who did not see a specialist when desired were more likely to want to disenroll from the health plan than patients who saw the specialist (40% vs 18%, p </=.001) and more likely not to recommend their group to a friend (38% vs 13%, p </=.001).
  
  
  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.
authors.affiliation: Center for Practice Management and Outcomes Research, VA Medical Center, Ann Arbor, Mich., USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Kerr
authors.forename: R D
authors.initials: RD
authors.lastname: Hays
authors.forename: A
authors.initials: A
authors.lastname: Mitchinson
authors.forename: M
authors.initials: M
authors.lastname: Lee
authors.forename: A L
authors.initials: AL
authors.lastname: Siu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011050:Policy Making; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data*