The internist as gatekeeper. Preparing the general internist for a new role

Area of Science:

• Health Services Research
• Medical Education

Background:

• Third-party payers are implementing gatekeeper systems to reduce healthcare costs.
• Primary care physicians (PCPs) are assigned to approve medical care, acting as gatekeepers.
• This model extends PCP responsibility from care coordination to direct control of medical services.

Purpose of the Study:

• To examine the role of primary care physicians as gatekeepers in managing healthcare costs.
• To identify challenges and requirements for successful implementation of the gatekeeper model.
• To emphasize the need for specific training for internists serving as gatekeepers.

Main Methods:

• Conceptual analysis of the gatekeeper model in healthcare.
• Review of the implications of PCP gatekeeping on cost-effectiveness and quality of care.
• Discussion of the educational needs for internists in this role.

Main Results:

• Gatekeeper systems require PCPs to approve most medical services, excluding emergencies.
• Obstacles exist that may hinder the cost-saving potential and quality of care in gatekeeper systems.
• Effective gatekeeping necessitates specific attitudes, skills, and knowledge for internists.

Conclusions:

• The gatekeeper model shifts PCP roles towards controlling medical care to manage costs.
• Addressing challenges is crucial for the success of gatekeeper systems in achieving cost-effectiveness and maintaining high-quality care.
• Medical education must adapt to prepare internists for their gatekeeping responsibilities.