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Does general practitioner gatekeeping curb health care expenditure?
D Delnoij1, G Van Merode, A Paulus
1Research Department, NIVEL (Netherlands Institute of Primary Care), Utrecht, The Netherlands.
Journal of Health Services Research & Policy
|May 2, 2000
Summary
Health care systems with general practitioners (GPs) as gatekeepers may slow ambulatory care spending growth. However, gatekeeping did not significantly impact overall health care costs or growth in this study of OECD countries.
Area of Science:
- Health Economics
- Health Services Research
- Comparative Health Systems
Background:
- General practitioner (GP) gatekeeping is theorized to reduce overall healthcare costs by controlling access to specialist care.
- Existing research often assumes gatekeeping systems lead to lower total healthcare expenditures.
Purpose of the Study:
- To investigate whether healthcare systems with GPs as gatekeepers have lower healthcare expenditures compared to systems with direct access to specialists.
- To determine if healthcare expenditure grows more slowly in countries with gatekeeping systems versus those without.
Main Methods:
- Multiple regression analyses were conducted on total and ambulatory healthcare expenditure data.
- The study included 18 Organisation for Economic Co-operation and Development (OECD) countries.
Main Results:
- Gatekeeping GPs were associated with slower growth in ambulatory care expenditure (P < 0.05).
- No significant effects of gatekeeping were observed on the level of ambulatory care costs, or the level or growth of total healthcare expenditure.
- Gross National Product (GNP) and public funding share were the primary drivers of aggregate healthcare costs and growth.
Conclusions:
- Gatekeeping systems show potential in controlling ambulatory care expenditure growth.
- Further research is needed to elucidate micro-level mechanisms and differentiate gatekeeping effects from other healthcare system structures.