Referral of children to specialists in the United States and the United Kingdom
Referral of children to specialists in the United States and the United Kingdom
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DOI：
10.1001/archpedi.157.3.279
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发表时间：
2003-03-01
影响因子：
--
通讯作者：
Bindman, AB
中科院分区：
文献类型：
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作者：
Forrest, CB;Majeed, A;Bindman, AB
目的：比较美国（US）和英国（UK）儿童专科转诊的比率和模式。设计：对1996年（美国）和1997年（英国）获得的医疗保健索赔/就诊数据进行回顾性队列分析。背景：美国的儿童从5个以初级保健医生为看门人的管理健康计划中选择：2个健康维护组织和3个服务点计划。服务点计划允许病人自我转诊，但增加了自付费用。在英国，全科实践研究数据库提供了211个全科实践的数据。参与者：从出生到17岁的儿童，在美国（n=135092）没有医生服务费用分担，并且在英国注册了全科医生，他们都授权患者获得专科护理（n=221312）。主要结果测量：每年转诊到专科医生的儿童百分比。结果：在美国的5个计划中，每年有18.6%至28.8%的患者被转诊，而英国样本中每年有8.7%的患者被转诊。转诊率在健康维护组织和由单一保险公司管理的服务点计划之间没有显著差异。与英国样本的患者相比，美国计划的患者转诊到医学专家的频率是英国样本的1.9倍，转诊到外科专家的频率是英国样本的3.2倍。患有特定疾病的儿童在特殊转诊率方面存在相当大的跨国差异。结论：与英国的同行相比，美国管理护理计划中的儿童被转介给专家的可能性在2到3倍之间。虽然这些转诊率差异很大，但我们的研究结果不能解释为美国的转诊率过高或英国的转诊率过低。与英国相比，美国有更多的专家，对直接获得专业护理的期望也更高，这可能是儿童专业转诊率差异的原因。
Objective: To compare the rates and patterns of children's specialty referrals in the United States (US) and the United Kingdom (UK).Design: Retrospective cohort analysis of health care claims/encounter data obtained in 1996 (US) and 1997 (UK).Setting: Children in the US were selected from 5 managed health plans that used primary care physicians as gatekeepers: 2 health maintenance organizations and 3 point-of-service plans. Point-of-service plans allow patient self-referral at increased out-of-pocket costs. In the UK, the General Practice Research Database provided data from 211 general practices.Participants: Children, from birth to the age of 17 years, with no cost sharing for physician services in the, US (n=135092) and who were registered with general practitioners, all of whom authorize patients' access to specialty care, in the UK (n=221312).Main Outcome Measure: Annual percentage of children referred to a specialist.Results: Across the 5 US plans, 18.6% to 28.8% of the patients per year were referred vs 8.7% of the patients per year in the UK sample. Referral rates were not significantly different between a health maintenance organization and a point-of-service plan administered by a single insurer. Compared with patients in the UK sample, those in the US plans were 1.9 times more commonly referred to medical specialists and 3.2 times more commonly referred to surgical specialists. There was considerable cross-national variation in specialty-specific referral rates for children with selected conditions.Conclusions: Children in US managed care plans are between 2 and 3 times as likely to be referred to specialists compared with counterparts in the UK. Although these referral rate differences are substantial, our findings cannot be construed to mean that the US referral rates are too high or that the UK rates are too low. The greater supply of specialists and higher expectations for direct access to specialty care in the US, compared with the UK, are likely explanations for these differences in children's specialty referral rates.