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The effects of gatekeeping: a systematic review of the literature

Marcial Velasco Garrido1, Annette Zentner, Reinhard Busse

  • 1Department of Health Care Management, Berlin University of Technology, Berlin, Germany. marcial.velasco@tu-berlin.de

Scandinavian Journal of Primary Health Care
|January 4, 2011
PubMed

Insights

Physician gatekeeping systems can reduce healthcare utilization and costs, but evidence on their impact on patient health outcomes is limited and inconclusive. Further research is needed to fully understand the effects of this healthcare model.

Area of Science:

  • Health Services Research
  • Health Economics
  • Systematic Review Methodology

Background:

  • Physician-centered gatekeeping, where a primary care physician acts as a first point of contact, is a common model in healthcare systems.
  • Understanding the impact of this model on health outcomes, healthcare utilization, and costs is crucial for healthcare policy and resource allocation.

Purpose of the Study:

  • To systematically review the existing literature on the effects of physician-centered gatekeeping.
  • To assess the impact on health, healthcare utilization, and economic outcomes.

Main Methods:

  • Systematic literature search of PubMed, EMBASE, and Cochrane Library up to January 2010.
  • Inclusion of RCTs, CCTs, cohort studies, CBAs, and interrupted time-series with physician gatekeepers.
  • Independent data extraction and quality assessment by two reviewers.

Main Results:

  • The review included 26 studies, primarily from the United States.
  • Gatekeeping was generally associated with reduced healthcare utilization (up to -78%) and expenditures (up to -80%).
  • Significant variability in outcomes and limited data on health and patient-related outcomes were noted.

Conclusions:

  • The overall quality of evidence on physician gatekeeping is limited.
  • While utilization and cost reductions are suggested, effects on health and patient-reported outcomes are inconclusive.
  • Further high-quality research is needed, particularly on patient-centered outcomes.
Abstract

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