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Related Experiment Videos

Gatekeeper effects on patterns of physician use.

R E Hurley1, D A Freund, B J Gage

  • 1Department of Health Policy and Administration, Pennsylvania State University, University Park.

The Journal of Family Practice
|February 1, 1991
PubMed
Summary

Primary care gatekeeping reduced specialist visits for Medicaid beneficiaries. Primary care use increased only when gatekeepers were fee-for-service, indicating a shift towards more structured, though clinically uncertain, care.

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Area of Science:

  • Health Services Research
  • Health Economics
  • Primary Care Medicine

Background:

  • Primary care gatekeeping models aim to manage healthcare utilization and costs.
  • Medicaid beneficiaries often face challenges accessing consistent and coordinated care.

Purpose of the Study:

  • To evaluate the effect of primary care gatekeeping on physician utilization patterns among Medicaid beneficiaries.
  • To assess how payment models for gatekeepers influence care-seeking behaviors.

Main Methods:

  • Analysis of physician use patterns in two Medicaid demonstration programs with primary care gatekeepers.
  • Comparison of healthcare utilization between enrolled beneficiaries and non-enrolled control groups.

Main Results:

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  • Beneficiaries with gatekeepers showed significantly lower rates of specialist visits compared to controls.
  • Primary care visits increased to compensate for reduced specialist use, but only under fee-for-service gatekeeper arrangements.
  • Enrolled beneficiaries utilized fewer healthcare sources, suggesting more concentrated care.

Conclusions:

  • Primary care gatekeeping can restructure care delivery, leading to reduced specialist use and fewer care sources.
  • The impact of these changes on clinical outcomes and long-term economic effects requires further investigation.
  • Fee-for-service compensation for gatekeepers may be crucial for maintaining primary care visit volume.