Effect of a gatekeeper plan on health services use and charges
A randomized trial
Bibliographic Data
| ID | 11026469 |
|---|---|
| Authors | Diane P Martins (0000-0002-4809-5040, University of Washington), D P Martin, Paula Diehr (Pennsylvania State University), Kurt Price (Pennsylvania State University), K F Price, William C Richardson (0000-0002-5979-1156, Pennsylvania State University) |
| Year | 1989 |
| Volume | 79 |
| Issue | 12 |
| Pages | 1628-1632 |
| Publication date | 1989-12-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | American Journal of Public Health (JOURNAL) |
| Journal identifiers | ISSN: 0090-0036 • E-ISSN: 1541-0048 |
| Publisher | American Public Health Association (PUBLISHER • US) |
| DOI | 10.2105/ajph.79.12.1628 |
| PMID | 2510523 |
| OpenAlex | W2045715720 |
| Language | EN |
| Citations received | 19 |
| References cited | 7 |
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
Ambulatory · Environmental health · Family medicine · Health care · Health insurance · Health plan · Incentive · Limiting · Plan (archaeology) · Randomized controlled trial · Healthcare Policy and Management · Medicine · Patient Satisfaction in Healthcare · Primary Care and Health Outcomes
Seven Financing Models
Health Politics
Hospitals, Doctors and Nurses
Healthcare Expenditure and Insurance Coverage
Funding Healthcare
Healthcare Provision
Healthcare Reforms over the Last Thirty Years
Conclusions
Financing and Provision
Comparative Health Systems
Socioeconomic Position and Health among Persons with Diabetes Mellitus
Contribution of Primary Care to Health Systems and Health
A qualitative study of the difficulties in reaching sustainable universal health insurance coverage in Iran
Health care expenditures after introduction of a gatekeeper and a global budget in a Swiss health insurance plan
Economic efficiency of gatekeeping compared with fee for service plans
Primary care case management and birth outcomes in the Iowa Medicaid program
Health Expenditures for Privately Insured Adults Enrolled in Managed Care Gatekeeping vs Indemnity Plans
Entry into primary care and continuity
Managed Health Plan Effects on the Specialty Referral Process
| Citations per year | 0.66 |
|---|---|
| Citation span | 1997 - 2021 (25) |
| Highly cited | No |