Gatekeeper effects of patterns of physician use

In an effort to structure and coordinate healthcare service delivery, primary care gatekeeper programs were developed to enlist the participation of primary care physicians. Participating providers agree to be the primary physician for a group of enrollees in the program. One anticipated benefit of gatekeeper programs is that the elimination of 'doctor shopping' will cut down on inefficient services and discontinuous care, preventing patients from going from doctor to doctor. Cost efficiency was also once anticipated as a benefit of this type of program, but cost-savings have been limited. Professional resistance, along with high resource requirements have also led to difficulties in implementation. These programs are designed to change care-seeking and providing behaviors. Patients have little choice; it is left up to physicians to decide which conditions they will treat and which cases they will refer to specialists. Data from two gatekeeper programs were gathered and compared with data from beneficiaries not enrolled in such programs; all patients were Medicaid recipients. Data samplings groups use in this study contained approximately 1,000 adults and 2,000 children. Access to specialists was restricted for program participants. Providers tended to be primary care physicians and tended to perform most treatments themselves. Enrollees usually saw only one or two providers a year, hence care was consolidated as intended by the programs. Evaluation of whether decreased access to specialists for enrollees in gatekeeper programs had a negative effect on overall patient care was not a part of this study. It is suggested that the gatekeeper programs be expanded so that appropriate medical care can be more efficient and available. However, such programs are not necessarily as cost-efficient as they had once been hoped to be. (Consumer Summary produced by Reliance Medical Information, Inc.)
Public and private purchasers of medical services have turned to the enrollment of beneficiaries with primary care gatekeepers to contain cost and improve access. Physicians who agree to contain cost [...]