Gatekeeping in primary care : consequences for population's health

Abstract

In this master thesis we address the concept of gatekeeping in primary care and examine consequences that it may have on aggregate health indicators of the nation.

The foundation for the research is a theory concerning health care market and physician behavior as well as empirical studies informing that gatekeeping can lead to restricted access to specialist and consequently might result in worse population health outcomes, because a specialist care is more effective for certain medical conditions. Our main hypothesis is that, a “strict gatekeeping” model will negatively affect population’s health between countries.

In order to examine the effects of a strict gatekeeping on population’s health, we compare 28 OECD member countries with different models of access to specialist care (i.e. strict/loose/none gatekeeping) over a period of 11 years (from 1997-2008 years).

We analyze cross section-time series dataset by means of panel data analysis. Random effects/Generalized Least Squares (GLR) regressions are performed for a number of population’s health indicators (PYLLs) with various demand and supply-side independent variables including in the different regression models.

The study results suggest that in general a strict gatekeeping model is positively associated with premature mortality between 28 OECD member countries, even when controlling for various demand and supply-side factors. However, since the research findings are subject to certain limitations (e.g. missing data, PYLL’s limitations etc), the results should be interpreted with caution and used to raise further questions as well as promote future research to explore deeper negative consequences of a strict gatekeeping arrangements in primary care on population’s health.