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Patients in Managed Care Plans Value the Role of Primary Care Physicians but Want Them to Be Coordinators, Not Gatekeepers

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Press Release Date: July 20, 1999

Nine of every 10 California patients in managed care plans say that they value having a primary care doctor provide their everyday care, and 89 percent say that they value having a primary care doctor coordinate their specialty care, according to a new study sponsored by the U. S. Agency for Health Care Policy and Research (AHCPR). But nearly a quarter of the patients studied had difficulty getting referrals to specialty care, which according to researchers is a reason why some may lose trust and confidence in their primary care doctors. The study, "Resolving the Gatekeeper Conundrum: A Study of What Patients Value in Primary Care and Referrals to Specialists," is being published in the July 21, 1999 issue of JAMA.

John M. Eisenberg, M. D., AHCPR's administrator, said, "While this study documents that almost all patients in managed care plans highly value their primary care clinician, it also tells us that one of the important roles of a personal physician is to facilitate patients' access to high quality specialists at the right time in the course of an evaluation or treatment."

The study team, led by Kevin Grumbach, M.D. of the University of California, San Francisco (UCSF) and Joe V. Selby, M.D., M.P.H., of Kaiser Permanente Medical Care Program of Northern California, Division of Research, Oakland, CA, asked approximately 7,700 patients in managed care plans who received care from one of several large medical groups in California about their attitudes toward their primary care physicians and their perceptions of barriers to specialty care. Patients were also asked to rate the performance of their primary care physicians on three dimensions: trust, confidence in quality of care and overall satisfaction.

Other findings include:

  1. 75 percent-91 percent of patients studied preferred to seek care first from their primary care physicians, depending on the specific medical problem. Most patients wanted their primary care physicians to assist in coordinating referrals to specialists when needed.
  2. 85 percent of patients reported that all or most of the time they trusted their primary care physicians to do the best for them.

Dr. Grumbach, director of the study, said that "Our study shows that patients value having a primary care physician. But they don't want managed care plans to turn their primary care physician into a rationer of specialty care." Dr. Grumbach added, "Patients want good primary care. They also want their primary care physician to have the freedom to refer them to a specialist when needed. Many managed care plans have financial incentives and other "gatekeeper" policies that may discourage primary care physicians from making referrals."

Note to Editors: For interviews of Dr. Grumbach, call Lordelyn P. del Rosario or Rebecca Nowlis at UCSF News Office at (415) 476-2557.

For additional information, please contact AHCPR Public Affairs, (301) 427-1364: Karen Migdail (301) 427-1855 (

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