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Susmita Pati, MD, Steven Shea, MD, MS, Daniel Rabinowitz, PhD and Olveen Carrasquillo, MD, MPH

At the time of the study, Susmita Pati was with the Departments of Pediatrics and Internal Medicine, Daniel Rabinowitz was with the Department of Statistics, and Steven Shea and Olveen Carrasquillo were with the Division of General Internal Medicine, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY. Steven Shea was also with the Division of Epidemiology, and Olveen Carrasquillo was also with the Division of Health Policy and Management, Mailman School of Public Health, Columbia University.

Correspondence: Requests for reprints should be sent to Olveen Carrasquillo, MD, MPH, Division of General Medicine, Columbia University College of Physicians and Surgeons, PH 9 East, Room 105, 622 West 168th St, New York, NY 10032 (e-mail: oc6{at}columbia.edu; pati{at}email.chop.edu).

Objectives. We assessed the ability of managed care gatekeeping strategies (i.e., requiring a designated primary care provider to authorize referrals) to control health care costs in the mid-1990s.

Methods. We analyzed expenditure data from 8195 privately insured adults sampled in the nationally representative 1996 Medical Expenditure Panel Survey. Managed care gatekeeping plan enrollees included those in health maintenance organizations and other plans requiring a primary care gatekeeper. All others were considered indemnity plan enrollees.

Results. In 1996, total per capita annual health expenditures for adult gatekeeping enrollees were about $50 less than those of indemnity enrollees, primarily owing to lower out-of-pocket expenditures. After multivariate adjustment, mean per capita expenditures were approximately 6% lower for gatekeeping enrollees than for indemnity enrollees.

Conclusions. In the private sector, gatekeeping strategies resulted in modest cost savings over indemnity plans.

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				S. A. Mohanty, S. Woolhandler, D. U. Himmelstein, S. Pati, O. Carrasquillo, and D. H. Bor Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis Am J Public Health, August 1, 2005; 95(8): 1431 - 1438. [Abstract] [Full Text] [PDF]