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Updated: Jun 22, 2026

TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients

TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients

Published on: April 13, 2021

Gatekeeping versus direct-access when patient information matters.

Paula González¹

¹Dpto. Economía, Métodos Cuantitativos e Historia Económica, Universidad Pablo de Olavide, Sevilla, Spain. pgonzalez@upo.es

Health Economics

|June 19, 2009

Summary

A non-gatekeeping healthcare system is better when patient pressure for referrals is high and patient health information quality is moderate. This balances referral efficiency and general practitioner agency costs.

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Published on: April 12, 2021

Area of Science:

Health Economics
Healthcare Management
Public Health Policy

Background:

Gatekeeping in healthcare systems influences patient access to specialists.
Patient self-health information and direct pressure on general practitioners (GPs) impact referral decisions.
Understanding the principal-agent dynamics between health authorities, patients, and GPs is crucial for system design.

Purpose of the Study:

To analyze the economic implications of gatekeeping versus non-gatekeeping healthcare models.
To evaluate the role of patient-provided health information and patient pressure in referral decisions.
To determine optimal healthcare system structures considering GP incentives.

Main Methods:

Development of a principal-agent economic model.
Simulation of health authority, patient, and general practitioner interactions.
Analysis of referral incentives under varying information quality and patient pressure.

Main Results:

Non-gatekeeping systems are favored only under specific conditions of high patient referral pressure.
The quality of patient self-health information significantly influences the efficiency of non-gatekeeping models.
Moderate patient information quality, coupled with high referral pressure, supports non-gatekeeping.

Conclusions:

Healthcare system design must account for patient agency and information asymmetry.
Gatekeeping effectiveness is contingent on balancing patient autonomy with provider incentives.
Policy implications suggest tailoring gatekeeping policies to specific patient populations and information environments.