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Gatekeeping may not be cost effective

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7321.1090/f (Published 10 November 2001) Cite this as: BMJ 2001;323:1090
  1. Deborah Josefson
  1. San Francisco

    Restricting access to specialists through “gatekeeping” does not significantly reduce specialist referrals and is not necessarily cost effective, a new study has said (New England Journal of Medicine 2001;345:1312-7).

    Gatekeeping in the United States is the process of requiring insured patients to see a primary care doctor for an initial assessment and examination before being allowed to consult a specialist. As in the NHS in the United Kingdom, the US primary care doctors may choose to treat the patients themselves or to refer them for specialist care. The system has been widely embraced by both health maintenance organisations and traditional insurers as a cost containment method.

    In April of 1998 Harvard Vanguard Medical Associates, a multispecialty prepaid group practice (previously …

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