Question

Managed care organizations emphasize physicians' responsibilities to control patient access to expensive hospitalization and specialty care, a principle dubbed "gatekeeping." Some argue that "gatekeeping" is unethical because it introduces financial factors into treatment decisions. Others say it improves quality by promoting the use of the most appropriate levels of care.

Answer 1

Gatekeeping is a healthcare system where physician acts as a link between primary care and secondary/tertiary care of a patient. Gatekeeping is a mechanism of care referral developed in countries with scarce medical  resources. In these countries patients are denied access to specialist of secondary/ tertiary care as an initial entry to healthcare despite patients wish to see the one. Gatekeeping is thought to have beneficial effects on overall healthcare system of a nation. It is argued to be an effective measure to maintain the costs by reducing the volume of unnecessary interventions. Primary healthcare and associated tests and diagnostic procedures are less expensive than secondary care. Moreover physician's have better understanding regarding whether patient needs specialist care , where to get the specialist care and how to seek it. Various studies have compared non gatekeeping and gatekeeping systems of various countries and it was found that patients countries with non gatekeeping systems visit 4 times more frequently to secondary/tertiary care systems. This leads to over utilization of secondary and tertiary care facilities. Also the healthcare cost to these states was higher than gatekeeping countries. In gatekeeping system physician collaborates with the patient in identifying their needs and then provide the best possible service to effectively meet the demands of the patient. In US gatekeeping system is criticized because public perceived that this system was influenced by financial considerations. Due to this criticism guidelines are being considered for improving the role and appropriateness of physician in referrals.

In my view although gatekeeping introduces financial factors into the treatment decision, this system is beneficial to the individual and to the state as well. Gatekeeping system if managed effectively can improve the standard and quality of health care delivery and facility in a country. Also with few resources at hand gatekeeping is making it possible to meet the needs and satisfy the demands of all. That is why gatekeeping concept has gained widespread support and public acceptance has also stregnthened.