title: Do specialist self-referral insurance policies improve access to HIV-experienced physicians as a regular source of care?
abstract: Health insurance policies that require prior authorization for specialty care may be detrimental to persons with HIV, according to evidence that having a regular physician with HIV expertise leads to improved patient outcomes. The objective of this study is to determine whether HIV patients who can self-refer to specialists are more likely to have physicians who mainly treat HIV. The authors analyze cross-sectional survey data from the HIV Costs and Services Utilization Study. At baseline, 67 percent of patients had insurance that permitted self-referral. In multivariate analyses, being able to self-refer was associated with an 8-12 percent increased likelihood of having a physician at a regular source of care that mainly treats patients with HIV. Patients who can self-refer are more likely to have HIV-experienced physicians than are patients who need prior authorization. Insurance policies allowing self-referral to specialists may result in HIV patients seeing physicians with clinical expertise relevant to HIV care.
authors.affiliation: Charles R.Drew University of Medicine and Science, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Heslin
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Andersen
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Kominski
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Belin
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.forename: William E
authors.initials: WE
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000191:economics / Q000706:statistics & numerical data*; D004470:Economics, Medical; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000628:therapy*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000145:classification / Q000706:statistics & numerical data*; D008297:Male; D008511:Medicine / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D010358:Patient Participation / Q000191:economics*; D011787:Quality of Health Care; D013038:Specialization; D011795:Surveys and Questionnaires; D014481:United States; D014600:Utilization Review