Comparison study of a centralized versus a decentralized method of utilization control of outpatient services in a health maintenance organization

This study compared a centralized to a decentralized method of utilization control of outpatient services in FHP, a Health Maintenance Organization, located in Utah. Referral rates and outside specialty costs were employed to examine the effect of each method. Additionally a provider questionnaire and FHP member questionnaire were used to assess their respective preference of the centralized and decentralized systems. The results indicate that the referral rate decreased by twenty-two percent and cost of outside specialty care decreased by eighteen percent. FHP providers expressed increased satisfaction with the decentralized method of utilization control The subscriber questionnaire results indicate definite shortening of the length of time it took to notify members of the referral disposition with the decentralized method. In general, members expressed a preference for the decentralized method. The transmittal of information to members regarding their referrals did not indicate that the decentralized method was better than the centralized method. Overall, the sample population for the member questionnaire was too small to attain statistical significance.