[E-health and the GP as gatekeeper; are the two compatible?]

Area of Science:

• Healthcare policy
• Digital health
• Primary care

Background:

• The general practitioner (GP) acts as a gatekeeper in the Dutch healthcare system, controlling access to specialist care.
• E-health enables medical specialists to directly inform patients about their services and offer consultations.
• This direct specialist-to-patient interaction via e-health potentially bypasses the traditional GP gatekeeping role.

Purpose of the Study:

• To analyze the implications of e-health consultations bypassing the GP gatekeeper in the Dutch healthcare system.
• To examine the regulatory and financial challenges associated with direct e-health access to specialists.
• To prompt consideration of the desirability of bypassing the gatekeeper in primary and specialist care collaboration.

Main Methods:

• Conceptual analysis of the Dutch healthcare system's structure.
• Review of e-health functionalities and their impact on patient pathways.
• Discussion of current regulatory gaps concerning e-health service payments.

Main Results:

• E-health facilitates specialists in directly engaging with patients, circumventing the GP gatekeeper.
• The Dutch healthcare system currently lacks mechanisms to regulate payment for such direct e-health services.
• Bypassing the gatekeeper, despite e-health benefits, may lead to increased healthcare costs.

Conclusions:

• The rise of e-health necessitates a critical evaluation of the gatekeeper model in Dutch healthcare.
• Regulatory frameworks must adapt to address payment and oversight for direct e-health specialist access.
• Careful consideration is needed to balance e-health advantages with potential financial and systemic consequences.