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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Kevin C. Heslin, PhD, Research Centers in Minority Institutions, Charles R. Drew University of Medicine and Science, 10833 Le Conte Avenue, Room 31-254A CHS, Los Angeles, CA 90024-1006, 310-313-0413, kheslin@ucla.edu, William E. Cunningham, MD, MPH, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Center for Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095, and Ronald M. Andersen, PhD, Department of Health Services, UCLA, 10833 Le Conte Avenue, Room 31-254A CHS, Los Angeles, CA 90024-1006.
State legislators are making efforts to ensure that HIV patients can see specialist physicians without first obtaining referrals from a primary care gatekeeper. Previous research has not evaluated whether patients whose insurance allows them to self-refer have better access to specialists than do patients who need prior authorization. Analyzing data from a nationally representative study, we estimated the proportion of HIV patients in the United States with self-referral insurance policies and the association of such coverage with having an infectious disease specialist as a regular source of care. In structured interviews, 2,864 patients were asked whether their insurance allowed them to self-refer to specialists. Physicians who treated these patients completed a questionnaire that asked about their residency training. In estimating the association of insurance with having an infectious disease specialist, propensity scores and stratified analysis were used to account for biased selection of self-referral policies. Results show that 52% of patients had insurance that permitted self-referral to specialists. Among patients whose physicians completed the survey (73% response rate), 44% had an infectious disease specialist as a regular source of care. Results show that patients who could self-refer had greater odds of having an infectious disease specialist than did patients without this option (OR=1.26; 95% CI=1.04, 1.48). Laws requiring health plans to offer their HIV+ members open referrals may improve access to infectious disease specialists. As organizations develop official criteria for defining "HIV specialists," future research should examine the relationship of self-referral insurance policies and the use of such providers.
Learning Objectives: At the conclusion of the session, the participant in this session will
Keywords: Insurance, Access to Health Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.