Is this referring to the fact that you have to go to your primary physician to get a referral for everything in an HMO?
Advantage: you have a single doctor who keeps tabs on your care
Disadvantage: You can have a jerk doctor who tells you "pain is normal for you" and won't give you the referral. I had a PPO and went to a specialist against the advice of my doctor and it turned out I really did need surgery.
Also, you are paying 2 doctors for the same issue. If you have a knee problem, the GP can't help you beyond prescribing pain meds or physical therapy. You'll still need to see the specialist, why not just go there first. On the other hand, people aren't as in tune with their medical issues as me LOL, and may not know what they really need and go to a specialist that costs 3 times as much when they didn't need to.
I don't think the gatekeeper/referral is as big of an issue as the fact that there are so FEW dr's who will take HMO's that it's simply difficult to get care and care can be delayed. If I could see my dr in a few days, then get into the specialist in another few days, no big deal. If you have to wait 4 weeks to see your doc then wait another 6 weeks to see a specialist, that's not OK. If you have to drive 50 miles cause most doc's don't take your HMO, that's not OK either. | 