Primary Care Practice Ownership and Specialist Use

A recent study published in ASR examined the patterns of pediatric primary care utilization among commercially insured children with disabilities. The study, written by a team of researchers including Department of Health Care Policy Research Associate, Nancy Beaulieu, PhD, and Professor of Health Care Policy, Mary Beth Landrum, PhD, found that the majority of children were treated in independent practices rather than system-owned ones. While there were no significant differences in the likelihood of seeing a specialist between the two types of practices, children in independent practices had fewer specialist visits on average.

Key findings and implications:

• Prevalence of independent practices: The high prevalence of independent practices suggests that they play a crucial role in providing primary care services to children with disabilities.
• Specialist utilization: The study highlights the importance of specialists in the care of children with disabilities, with nearly two-thirds of children using at least one specialist.
• Variation in specialist use: The patterns of specialist use varied based on child age and specialist type, emphasizing the need for tailored care approaches.
• Practice ownership and specialist visits: While practice ownership did not significantly influence the likelihood of seeing a specialist, it did affect the frequency of specialist visits. Children in system-owned practices had a slightly higher average number of specialist visits.

The potential reasons for the observed differences in specialist visits between independent and system-owned practices include system-owned practices may have access to more resources or specialized services, making it easier for them to refer patients to specialists. Additionally, system-owned practices often have stronger care coordination mechanisms in place, which can lead to more efficient and frequent specialist referrals. Geographic factors also play a role, as the distribution of independent and system-owned practices in different regions can influence access to specialists and the overall pattern of care. Finally, patients may have personal preferences for specific types of practices or providers, which can impact their choice of primary care and specialist care.

To gain a deeper understanding of these factors and inform efforts to improve care for children with disabilities, future research should focus on longitudinal studies examining changes in practice ownership and specialist use over time, evaluations of the quality of care provided in different practice settings, comparisons of the costs associated with care in independent and system-owned practices, and assessments of patient satisfaction with care received in different practice settings. By exploring these areas, we can better understand the factors influencing primary care practice choice and specialist use among children with disabilities and develop more effective strategies to improve the quality and accessibility of care for this vulnerable population.