Pity the poor gatekeeper: a transatlantic perspective on cost containment in clinical practice.

Taylor, T. R.

doi:10.1136/bmj.299.6711.1323

Cited by 19 publications

(9 citation statements)

References 13 publications

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“…Limited research suggests that primary care physicians themselves have considerable ambivalence about their role as gatekeepers in managed care systems. [16][17][18][19][20] However, little is known about how patients view the role of primary care physicians as coordinators of care. We investigated patient attitudes toward the involvement of their primary care physicians in access to specialty care.…”

mentioning

confidence: 99%

Resolving the Gatekeeper Conundrum

Grumbach

Selby²,

Damberg³

et al. 1999

JAMA

212

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confidence: 99%

Resolving the Gatekeeper Conundrum

Grumbach

Selby²,

Damberg³

et al. 1999

JAMA

212

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“…a fixed payment per individual) with this occurring mainly when patient registration or enrolment exists; and (c) a mixture of the two [8,9,10]. Thus, how the budget is set will have a key impact on the ultimate incentives that dominate.…”

Section: Budgetary Models and Incentives In Theorymentioning

confidence: 99%

Devolved budgetary responsibility in primary care

Wilton

Smith

2002

Eur J Health Econom

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General Practitioners and primary care physicians have a pivotal role in the allocation of health care resources in most countries. With increasing costs of care, they have therefore become a significant focus for healthcare reform in the pursuit of increased efficiency. For example, the United Kingdom (UK), United States of America (USA), New Zealand (NZ), Germany and The Netherlands, have all pursued reforms introducing explicit budgetary responsibilities for primary care. While there is a common set of objectives underlying such budgetary responsibilities, different versions have been introduced to reflect specific health environments. As most of these reforms were introduced in the early to middle 1990s, it is timely to examine their impact on efficiency. This paper therefore provides an econometric assessment of the effect of budgetary arrangements in the UK, USA, NZ, Germany and The Netherlands on the growth of primary care expenditure and flow-on costs (as proxied by pharmaceutical expenditure), as proxy indicators for efficiency. The results suggest that for all countries there is some support for efficiency improvements through the implementation of budgets for primary care.

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“…For example, in an attempt to screen out unnecessary treatments, there may be new regulations for authorizing referrals to specialists, and hospital admissions, and for ordering laboratory or other diagnostic services. One consequence is that these regulations may potentially reduce patients' access to services and cast physicians increasingly in the role of gatekeepers (Taylor, 1989). Indeed, studies show A: Components of Decentralization Program 1. allocation of a capitation-based line item budget to the clinic 2 .…”

Section: Changes In Clinic Work Proceduresmentioning

confidence: 99%

“…Financial considerations may even be perceived as contradicting the medical ethos (Scrivens, 1988). HMO physicians have reported that 'gatekeeping' compromised their role as patient advocates and was detrimental to gaining the trust of their patients (Taylor, 1989). These attitudes may, therefore, lower physicians' motivation to cooperate with the clinic's 'new' aims.…”

Section: Changes In Job Designmentioning

confidence: 99%

Quality of care in decentralized primary care clinics: A conceptual framework

Gross

Benbassat

Nirel

et al. 1992

Health Planning & Management

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In an attempt to provide high quality medical care, despite limited resources, health care providers in various countries have introduced decentralization into their health care services. It has been assumed that the delegation of authority to the local levels of the organization will enhance their ability to respond to local needs, and improve cost containment without compromising the quality of care. However, to date, few empirical studies have explored the relationship between decentralization and such projected outcomes. In this article we present a conceptual framework for analyzing possible consequences of decentralization on dimensions of quality of primary health care. We also suggest a framework for defining decentralization programs by their key components, and employ these frameworks to analyze a specific decentralization program being implemented in Israel's largest health maintenance organization (HMO). While we identify the dimensions most likely to be affected, we also conclude that data presently available do not permit a definitive prediction of whether the overall effect of decentralization on quality of care will be positive or negative. The potential reaction of a unit to the elements of change introduced by a decentralization program is influenced by the structural, cultural and management characteristics of that unit. Therefore, future attempts to decentralize health care organizations should be accompanied by close monitoring.

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Pity the poor gatekeeper: a transatlantic perspective on cost containment in clinical practice.

Cited by 19 publications

References 13 publications

Resolving the Gatekeeper Conundrum

Resolving the Gatekeeper Conundrum

Devolved budgetary responsibility in primary care

Quality of care in decentralized primary care clinics: A conceptual framework

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