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Related Experiment Videos

Switching to gatekeeping: changes in expenditures and utilization for children.

T G Ferris1, J M Perrin, J A Manganello

  • 1Institute for Health Policy, Division of General Medicine, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts 02114, USA. tferris@partners.org

Pediatrics
|August 3, 2001
PubMed
Summary

Parents with chronically ill children were less likely to enroll in gatekeeping health plans. Switching to gatekeeping reduced specialist visits for all children but did not improve primary care physician involvement for those with chronic conditions.

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Area of Science:

  • Health Services Research
  • Pediatric Health Economics
  • Managed Care Policy

Background:

  • Managed care organizations utilize gatekeeping strategies for cost containment.
  • Limited research exists on the impact of gatekeeping plans on pediatric healthcare expenditures and utilization.
  • Understanding these impacts is crucial for evaluating healthcare policy effectiveness.

Purpose of the Study:

  • To assess the enrollment likelihood of parents with chronically ill children in gatekeeping health plans.
  • To determine the effects of gatekeeping on healthcare expenditures and utilization for children, particularly those with chronic conditions.

Main Methods:

  • A cohort of 1839 children was followed from 1991-1994, comparing those who switched to a gatekeeping plan versus those who remained in an indemnity plan.

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  • The study analyzed enrollment patterns and mean annual healthcare expenditures and utilization (total, subspecialty, primary care).
  • Participants were children of employees from a large hospital, with a focus on children with chronic conditions.

    • Main Results:

    • Households with chronically ill children were less likely to enroll in the gatekeeping plan (8% vs. 15%).
    • Gatekeeping was associated with significant reductions in total (53%) and subspecialty (59%) expenditures for all children.
    • For children with chronic conditions, gatekeeping decreased subspecialist visits by 57% but did not increase primary care physician involvement.

    Conclusions:

    • Parents of chronically ill children showed lower adoption rates for gatekeeping plans.
    • Gatekeeping effectively reduced specialist utilization but did not enhance primary care physician management for complex pediatric cases.
    • The long-term health implications for children under gatekeeping models remain undetermined.