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Physicians as gatekeepers: will they contribute to restrict disability benefits?
1Department of Social Insurance Medicine, University of Oslo, Norway.
Scandinavian Journal of Primary Health Care
|February 5, 1999
Summary
General practitioners (GPs) acted as gatekeepers for disability benefits, maintaining their refusal recommendations despite stricter criteria. Their role remained crucial in managing social insurance access for patients.
Area of Science:
- Social Medicine
- Public Health Policy
- Healthcare Management
Background:
- Norway implemented stricter eligibility criteria for disability benefits in 1991.
- This policy change aimed to regulate access to social insurance benefits.
Purpose of the Study:
- To assess the reactions of general practitioners (GPs), specialists, and National Insurance Administration (NIA) medical consultants to the revised disability benefit criteria.
- To analyze physician recommendations in relation to benefit decisions before and after the policy change.
Main Methods:
- Comparative analysis of first-time disability benefit applicants' records from 1990 and 1993 in two Norwegian counties.
- Inclusion of all refused cases and half of granted cases (total 668 applicants).
Main Results:
- Applicant numbers decreased by 39%, and refusal rates rose from 8% to 21% between 1990 and 1993.
- GPs' refusal recommendation rates remained stable (8-9%), indicating a willingness to act as gatekeepers.
- NIA medical consultant involvement increased, with approximately 50% concordance with GPs' assessments.
Conclusions:
- General practitioners demonstrated a consistent willingness to serve as gatekeepers for social insurance benefits, even with tightened eligibility requirements.
- Physician roles and decision-making processes were analyzed in the context of evolving social welfare policies.