What term describes a situation where a patient chooses to bypass primary care and go directly to a specialist?

The term that best describes a situation where a patient chooses to bypass primary care and go directly to a specialist is "self-referral." This occurs when a patient takes the initiative to seek specialty care without needing a referral or authorization from a primary care provider. Self-referral allows patients more autonomy and the ability to make their own healthcare decisions regarding the specialists they choose to see.

In the context of health insurance and care delivery, understanding self-referral is important because it can affect the insurance coverage process. Many health plans may require that patients see a primary care provider first to secure a referral for specialist services. Bypassing this step can lead to different reimbursement levels and may not be covered by insurance, depending on the plan’s requirements.

While "direct access" might seem similar, it typically refers to healthcare systems that allow patients to see specialists without any prior requirements, such as the necessity for a primary care visit. However, it is more often a defined system established by a healthcare provider rather than an individual action taken by the patient.

The concepts of "gatekeeping" and "specialist referral" involve having a primary care provider manage patient referrals to specialists, which is counter to the essence of self-referral. In these scenarios, the primary care