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Gatekeeping and the Utilization of Physician Services in France: Evidence on the Médecin Traitant Reform

Author

Listed:
  • Magalie Dumontet

    (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres)

  • Thomas Buchmueller

    (Inserm U1219, Population Health Research Center - Université de Bordeaux)

  • Paul Dourgnon

    (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres)

  • Florence Jusot

    (LEDa - Laboratoire d'Economie de Dauphine - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres)

  • Jérôme Wittwer

    (Inserm (UMR 1219) - Université de Bordeaux)

Abstract

In 2005, France implemented a gatekeeping reform designed to improve care coordination and to reduce utilization of specialists' services. Under this policy, patients designate a médecin traitant, typically a general practitioner, who will be their first point of contact during an episode of care and who will provide referrals to specialists. A key element of the policy is that patients who self-refer to a specialist face higher cost sharing than if they received a referral from their médecin traitant. We consider the effect of this policy on the utilization of physician services. Our analysis of administrative claims data spanning the years 2000–2008 indicates that visits to specialists, which were increasing in the years prior to the implementation of the reform, fell after the policy was in place. Additional evidence from the administrative claims as well as survey data suggest that this decline arose from a reduction in self-referrals, which is consistent with the objectives of the policy. Visits fell significantly both for specialties targeted by the policy and specialties for which self-referrals are still allowed for certain treatments. This apparent spillover effect may suggest that, at least initially, patients did not understand the subtleties of the policy.

Suggested Citation

  • Magalie Dumontet & Thomas Buchmueller & Paul Dourgnon & Florence Jusot & Jérôme Wittwer, 2017. "Gatekeeping and the Utilization of Physician Services in France: Evidence on the Médecin Traitant Reform," Post-Print hal-02429628, HAL.
  • Handle: RePEc:hal:journl:hal-02429628
    DOI: 10.1016/j.healthpol.2017.04.006
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    Citations

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    Cited by:

    1. Matthieu Cassou & Julien Mousquès & Carine Franc, 2020. "General practitioners’ income and activity: the impact of multi-professional group practice in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1295-1315, December.
    2. Cassou, Matthieu & Mousquès, Julien & Franc, Carine, 2023. "General Practitioners activity patterns: the medium-term impacts of Primary Care Teams in France," Health Policy, Elsevier, vol. 136(C).
    3. Christophe Loussouarn & Carine Franc & Yann Videau & Julien Mousquès, 2021. "Can General Practitioners Be More Productive? The Impact of Teamwork and Cooperation with Nurses on GP Activities," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 680-698, March.
    4. Marchildon, Gregory P. & Brammli-Greenberg, Shuli & Dayan, Mark & De Belvis, Antonio Giulio & Gandré, Coralie & Isaksson, David & Kroneman, Madelon & Neuner-Jehle, Stefan & Saunes, Ingrid Sperre & Tho, 2021. "Achieving higher performing primary care through patient registration: A review of twelve high-income countries," Health Policy, Elsevier, vol. 125(12), pages 1507-1516.
    5. Simon Jean-Baptiste Combes & Alain Paraponaris & Yann Videau, 2019. "French GPs’ Willingness to Delegate Tasks: May Financial Incentives Balance Risk Aversion?," Working Papers halshs-02071522, HAL.
    6. Najwa Taghy & Viviane Ramel & Ana Rivadeneyra & Florence Carrouel & Linda Cambon & Claude Dussart, 2023. "Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviors in Primary Care for the Elderly—Qualitative Study," IJERPH, MDPI, vol. 20(2), pages 1-17, January.
    7. Natalya N. Sisigina, 2018. "Problems of Transition to a Gatekeeper Model in Healthcare," Finansovyj žhurnal — Financial Journal, Financial Research Institute, Moscow 125375, Russia, issue 3, pages 64-77, June.

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