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

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  • Martin, D.P.
  • Diehr, P.
  • Price, K.F.
  • Richardson, W.C.

Abstract

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 changes 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.

Suggested Citation

  • Martin, D.P. & Diehr, P. & Price, K.F. & Richardson, W.C., 1989. "Effect of a gatekeeper plan on health services use and charges: A randomized trial," American Journal of Public Health, American Public Health Association, vol. 79(12), pages 1628-1632.
    • Handle: RePEc:aph:ajpbhl:1989:79:12:1628-1632_1
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    Cited by:

    1. Paula González, 2010. "Gatekeeping versus direct‐access when patient information matters," Health Economics, John Wiley & Sons, Ltd., vol. 19(6), pages 730-754, June.
    2. Blomqvist, Ake & Leger, Pierre Thomas, 2005. "Information asymmetry, insurance, and the decision to hospitalize," Journal of Health Economics, Elsevier, vol. 24(4), pages 775-793, July.
    3. GONZALEZ, Paula, 2003. "The "gatekeeping" role of general practitioners. Does patients' information matter ?," LIDAM Discussion Papers CORE 2003089, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).

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