Physicians as Gatekeepers: A Complex Challenge
Reagan, Michael D.
New England Journal of Medicine. 1987 December 31; 317(27): 1731-1734.
In a cost-containment health care delivery setting, such as a prepaid plan or a for-profit institution, the physician-gatekeeper faces a role conflict in serving both as patient advocate and as guardian of institutional welfare. Yet some positive features of the primary care physician's gatekeeper function can also be identified. With less use of hospitalization and cost-intensive procedures, patients may be exposed less often to the risk of iatrogenic ill effects. Re-examination of standard treatments may result in improvements in care. Gatekeepers develop closer working relationships with other health professionals and with ethicists. Physicians are urged to be deeply involved in developing policies to oversee gatekeeper programs with regard to quality of care and possible conflict of interest, to devise "consumer protection" measures, to avoid compensation schemes tied to reducing services to specific patients, and to establish educational programs for gatekeepers. (KIE abstract)
Compensation; Conflict of Interest; Containment; Costs and Benefits; Consultation; Decision Making; Economics; Ethicists; Gatekeeping; Health; Health Care; Health Care Delivery; Hospitals; Incentives; Organizations; Patient Advocacy; Patients; Peer Review; Physician's Role; Physicians; Proprietary Hospitals; Referral and Consultation; Remuneration; Review; Risk; Risks and Benefits; Social Impact;
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