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Do Specialist Self-Referral Insurance Policies Improve Access to HIV-Experienced Physicians as a Regular Source of Care?

Charles R.Drew University of Medicine and Science

Ronald M. Andersen

Susan L. Ettner

Gerald F. Kominski

Thomas R. Belin

University of California, Los Angeles

Hal Morgenstern

University of Michigan

William E. Cunningham

University of California, Los Angeles

Health insurance policies that require prior authorization for specialty care may be detrimental to persons with HIV, according to evidence that having a regular physician with HIV expertise leads to improved patient outcomes. The objective of this study is to determine whether HIV patients who can self-refer to specialists are more likely to have physicians who mainly treat HIV. The authors analyze cross-sectional survey data from the HIV Costs and Services Utilization Study. At baseline, 67 percent of patients had insurance that permitted self-referral. In multivariate analyses, being able to self-refer was associated with an 8–12 percent increased likelihood of having a physician at a regular source of care that mainly treats patients with HIV. Patients who can self-refer are more likely to have HIV-experienced physicians than are patients who need prior authorization. Insurance policies allowing self-referral to specialists may result in HIV patients seeing physicians with clinical expertise relevant to HIV care.

Key Words: human immunodeficiency virus (HIV) • specialists • insurance plans • utilization

Medical Care Research and Review, Vol. 62, No. 5, 583-600 (2005)
DOI: 10.1177/1077558705279311


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