What requirement is associated with an HMO regarding patient referrals?

In the context of Health Maintenance Organizations (HMOs), a primary requirement is that patients must choose a primary care physician (PCP) to manage their healthcare. The PCP serves as a gatekeeper, meaning that they are responsible for coordinating care and providing referrals to specialists when necessary. This structure is designed to streamline patient care and ensure that specialists are only accessed when deemed medically appropriate by the primary care provider.

It is important to note that in an HMO, patients typically cannot see specialists without receiving a referral from their primary care physician, which underscores the role of the PCP. This system helps control costs and ensure that all care provided aligns with the patient's overall health plan. While patients may have a range of options for specialists once they receive a referral, the necessity of the primary care physician's involvement is a defining characteristic of HMOs.