HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Martin, D P Articles by Richardson, W C Search for Related Content PubMed PubMed Citation Articles by Martin, D P Articles by Richardson, W C

Effect of a gatekeeper plan on health services use and charges: a randomized trial.

D P Martin, P Diehr, K F Price and W C Richardson

Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle 98195.

A randomized trial was conducted to determine the effectiveness of a health care plan which uses physicians as gatekeepers to control health services use and charges. New enrollees in United Healthcare (UHC), an independent practice association, were randomly assigned to the standard UHC plan requiring a gatekeeper, or to an alternate plan with equal benefits but without a gatekeeper. Individuals in both plans were similar in demographic characteristics, perceived health status, and other health insurance coverage. The gatekeeper plan had 6 percent lower total charges per enrollee than the plan without a gatekeeper. There were minor differences in hospital use and charges. Ambulatory charges were $21 lower per person per year in the plan with a gatekeeper (95% CI = -39.9, -2.1) and these were due to .3 fewer visits to specialists (95% CI = -0.50, -0.10). We conclude that a health plan which incorporates incentives and penalties for physicians to act as gatekeepers can reduce the cost of ambulatory services by limiting specialist visits.

This article has been cited by other articles:

				M. Schwenkglenks, G. Preiswerk, R. Lehner, F. Weber, and T. D Szucs Economic efficiency of gatekeeping compared with fee for service plans: a Swiss example J. Epidemiol. Community Health, January 1, 2006; 60(1): 24 - 30. [Abstract] [Full Text] [PDF]

				S. Pati, S. Shea, D. Rabinowitz, and O. Carrasquillo Health Expenditures for Privately Insured Adults Enrolled in Managed Care Gatekeeping vs Indemnity Plans Am J Public Health, February 1, 2005; 95(2): 286 - 291. [Abstract] [Full Text] [PDF]

				M. C. Beach, L. S. Meredith, J. Halpern, K. B. Wells, and D. E. Ford Physician Conceptions of Responsibility to Individual Patients and Distributive Justice in Health Care Ann. Fam. Med, January 1, 2005; 3(1): 53 - 59. [Abstract] [Full Text] [PDF]

				A. F. Brown, S. L. Ettner, J. Piette, M. Weinberger, E. Gregg, M. F. Shapiro, A. J. Karter, M. Safford, B. Waitzfelder, P. A. Prata, et al. Socioeconomic Position and Health among Persons with Diabetes Mellitus: A Conceptual Framework and Review of the Literature Epidemiol. Rev., July 1, 2004; 26(1): 63 - 77. [Full Text] [PDF]

				C. B Forrest Primary care in the United States: Primary care gatekeeping and referrals: effective filter or failed experiment? BMJ, March 29, 2003; 326(7391): 692 - 695. [Full Text] [PDF]

				S. Pati, S. Shea, D. Rabinowitz, and O. Carrasquillo Does Gatekeeping Control Costs for Privately Insured Children? Findings From the 1996 Medical Expenditure Panel Survey Pediatrics, March 1, 2003; 111(3): 456 - 460. [Abstract] [Full Text] [PDF]

				T. G. Ferris, Y. Chang, J. M. Perrin, D. Blumenthal, and S. D. Pearson Effects of Removing Gatekeeping on Specialist Utilization by Children in a Health Maintenance Organization Arch Pediatr Adolesc Med, June 1, 2002; 156(6): 574 - 579. [Abstract] [Full Text] [PDF]

				T. G. Ferris, Y. Chang, D. Blumenthal, and S. D. Pearson Leaving Gatekeeping Behind -- Effects of Opening Access to Specialists for Adults in a Health Maintenance Organization N. Engl. J. Med., November 1, 2001; 345(18): 1312 - 1317. [Abstract] [Full Text] [PDF]

				T. G. G. Ferris, J. M. Perrin, J. A. Manganello, Y. Chang, N. Causino, and D. Blumenthal Switching to Gatekeeping: Changes in Expenditures and Utilization for Children Pediatrics, August 1, 2001; 108(2): 283 - 290. [Abstract] [Full Text] [PDF]

				M. D. Piehl, C. J. Clemens, and J. D. Joines "Narrowing the Gap": Decreasing Emergency Department Use by Children Enrolled in the Medicaid Program by Improving Access to Primary Care Arch Pediatr Adolesc Med, August 1, 2000; 154(8): 791 - 795. [Abstract] [Full Text] [PDF]

				C. B. Forrest, G. B. Glade, B. Starfield, A. E. Baker, M. Kang, and R. J. Reid Gatekeeping and Referral of Children and Adolescents to Specialty Care Pediatrics, July 1, 1999; 104(1): 28 - 34. [Abstract] [Full Text]

				T. Bodenheimer, B. Lo, and L. Casalino Primary Care Physicians Should Be Coordinators, Not Gatekeepers JAMA, June 2, 1999; 281(21): 2045 - 2049. [Abstract] [Full Text] [PDF]

				H. Tabenkin, R. Gross, S. Brammli, and P. Shvartzman Patients' Views of Direct Access to Specialists: An Israeli Experience JAMA, June 24, 1998; 279(24): 1943 - 1948. [Abstract] [Full Text] [PDF]

				D. E. Grembowski, K. Cook, D. L. Patrick, and A. E. Roussel Managed Care and Physician Referral Med Care Res Rev, March 1, 1998; 55(1): 3 - 31. [Abstract] [PDF]

				F. J. Hellinger The Impact of Financial Incentives on Physician Behavior in Managed Care Plans: A Review of the Evidence Med Care Res Rev, September 1, 1996; 53(3): 294 - 314. [Abstract] [PDF]

				R. M. Wachter and L. Goldman The Emerging Role of "Hospitalists" in the American Health Care System N. Engl. J. Med., August 15, 1996; 335(7): 514 - 517. [Full Text]

				J. P. Weiner The Demand for Physician Services in a Changing Health Care System: A Synthesis Med Care Res Rev, December 1, 1993; 50(4): 411 - 449. [PDF]