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[Do primary care physicians acting as gatekeepers really improve health outcomes and decrease costs? A systematic
A Zentner1, M Velasco Garrido, R Busse
1Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin. annette.zentner@tu-berlin.de
Gesundheitswesen (Bundesverband Der Arzte Des Offentlichen Gesundheitsdienstes (Germany))
|October 2, 2009
Summary
Primary care physicians (PCP) gatekeeping reduces specialist care use and healthcare costs. Health outcomes may be comparable to open access, but evidence quality is limited.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Health Economics
Background:
- Gatekeeping by primary care physicians (PCP) is a strategy to manage access to specialist care.
- The effectiveness and impact of gatekeeping on various healthcare outcomes require systematic evaluation.
Purpose of the Study:
- To systematically review the effects of PCP gatekeeping on specialist care access.
- To analyze impacts on health outcomes, quality of life, care utilization, costs, and patient/provider satisfaction.
Main Methods:
- Comprehensive literature search across multiple databases (Medline, EMBASE, Cochrane Library) and hand searches.
- Inclusion of diverse study designs (RCTs, cohort studies, controlled before-after studies, interrupted time series).
- Data extraction and quality assessment by two independent reviewers.
Main Results:
- 24 studies (1989-2007) from various countries, predominantly the USA, were included.
- 13 studies reported positive effects of gatekeeping, 2 negative, and 9 showed no difference.
- Gatekeeping was associated with decreased specialist care utilization and lower healthcare costs.
Conclusions:
- International evidence on gatekeeping is limited by study quality and applicability.
- PCP gatekeeping appears to reduce specialist utilization and costs.
- Health outcomes and quality of life may be comparable to open access, but evidence is limited and inconsistent for other parameters.
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