Access to Specialty Care

Despite complaints that the care provided by specialists is discontinuous and fragmented, Americans have traditionally valued their unrestrained access to care by cardiologists, dermatologists, urologists, and other specialists. But now the rapid spread of managed care is dramatically changing how referrals to specialists are made. For example, most health maintenance organizations (HMOs) sharply limit access to specialists by interposing a “gatekeeper” physician between the patient and the specialist, and in the process many patients have lost an element of control over the kind of care they receive.The cost of specialty care is a principal concern. Specialists are more expensive . . .