[GP (general practitioners)-centered care - international data and recent development in Germany with focus on...

Since the health-care reform in 1993, there are ambitious efforts of introducing gatekeeping in Germanys' primary health-care system. Gatekeeping is said to reduce costs and improve health-care quality. The aim of this article is to summarise the actual literature and the newest progression of gatekeeping for the example of Baden-Württemberg.

By means of a selective literature search, national and international data on gatekeeping are summarised.

Most available data on gatekeeping are from US-American studies whereas data from Germany are rare so far. The effects of gatekeeping are defined by means of various outcome measures (e.g., physician-patient relationship, health-care quality, visits, referrals, costs, prescribing behaviour). The observed effects in terms of these outcome measures are not uniform and are contradictory to a great extent. Newest data from GP (general practitioners)-centred care model regions in Germany indicate a high satisfaction among these patients. Furthermore, an increase of consultations at specialists with referrals from the gatekeepers could be observed whilst the overall number of referrals to specialists remained equal so far. Baden-Württemberg's first generation contracts for GP-centred care were based on different legal paragraphs resulting in partially considerable differences in terms of the conditions for physicians and patients.

On the basis of the available data, the effects of gatekeeping cannot conclusively be determined. In Germany, scientific evaluation of the different gatekeeping models and publication of their results are absolutely necessary to assess the expected cost saving and quality improving effects of gatekeeping.