Role of Gatekeeping Assignment

help cover their fees so that they can receive treatment (e.g vaccinations) for common health problems (e.g sore throat or diabetes). Thus, patients can cure their common health issues for a smaller price as the government insists on covering primary health care. Since common health problems such as vaccinations are supposed to be taken by the general public, gatekeeping actually aids in ensuring that the large scale health of the community is well taken care of. This is easily accomplished as Primary Health Care clinics are found within communities in large numbers.For example, the Primary Health Care Strategy policy passed in 2001 used government revenue to help copay primary care fees so that most citizens paid as little as five dollars for prescriptions. (Bodenheimer,Thomas SGrumbach, Kevin, 2009) However, unlike non-gatekeeping systems, patients in gatekeeping systems cannot directly go to a specialist when they face rare or complex disorders as they require a referral from their GPs before they can even meet a specialist.
Thus, patients become self-referral and take on the role of a primary care practitioner (PCP) and bring themselves to specialists whom they think would be suited to treat them. (Bodenheimer,Thomas SGrumbach, Kevin, 2009) It is important to note however that Cumming found out that the gatekeeping system actually helped patients to have continuous care as the specialists would pass on information to their PCPs. Patients who had GPs were able to have continuous care as their GPs would have a better understanding of their health history and would thus be able to better understand how to cater to patients needs more effectively. As compared to non-gatekeeping system where patients struggle to see different specialists who would not have a clear understanding of their medical history. According to studies conducted by Starfield (Starfield, 2003)it is shown that the communication and coordination between PCPs and specialists is comparatively lacking in the non-gatekeeping system, with less than 1⁄2 of family physicians being aware of whether a referral they had made had actually resulted in the patient visiting the specialist, and of those where it did, 80% of the referrals resulting in feedback letters to the PCP. There is a consensus among scholars like Starfield and Boheimer that because of the absence of gatekeeping in the system, the line between primary care and specialist care is blurred, causing the relationship between these two levels of health care to often be quite haphazard and uncoordinated, leaving patients to navigate “the maze” alone.
According to studies done by Kerr White, it was noticed that out of 750 people ill, at least 250 of them visited physicians, nine of them went to a hospital and one went to a university medical centre. This thus, suggests that more patients faced common health issues which required them to consult PCPs. It is not surprising that more patients were encountered in Primary Health care clinics as these clinics tackle common health issues faced by the public. Hence the system of gatekeeping is essential as it allows patients to have their common health problems checked instead of constantly consulting specialists by self referral as discovered in Cummings studies. In order to determine the positive and negative effects of gatekeeping, one can compare the effectiveness of health care between a non- gatekeeping system and gatekeeping system by comparing access, quality and efficiency. Access refers to ease of patients obtaining health care. As was paraphrased from Bodenheimer (2009), patients in the non-gatekeeping have unlimited access to specialists based on experience and reputation. Bodenheimer found that this freedom is considered a very positive feature from the patient perspective. Gatekeeping patients on the other hand, cannot directly access a specialist, and a specialist visit can take up to six months to occur after consultation (Cumming et al, 2009). This is a restriction, indicating reduced effectiveness in the gatekeeping system.. Another disadvantage is the impact gatekeeping has had on access due to funding equity and GP availability.

When considering the quality of health care, we look at doctor’s skill, to patient comfort and satisfaction (Roberts, 2008). In gatekeeping, improves continuity of care by enforcing GP involvement (excluding in emergencies which improves quality of health care, (Bodenheimer & Grumbach, 2009)There was a 19% decrease in mortality rates compared to keeping a specialist as a primary physician (Schoen et al., 2007). Due to gatekeeping, GP’s are more likely to be more familiar with a patient’s history.In the non-gatekeeping, ease of access means specialists are increasingly engaging in common-cause treatment, decreasing quality of care. Bodenheimer also shows that a key benefit to gatekeeping lies in the role of a coordinator. General Practitioners in the gatekeeping system can manage communication between specialists, serving as a knowledgeable source. When patients go to clinics, they attend clinics over a long period of time and this allows General Practitioners to observe health patterns on their patients as they will make it easier for specialists to pinpoint a cause for a patient’s illness. Specialists however cannot do this as they treat hundreds of cases each day in hospitals.Thus, gatekeeping ensures that patients get proper quality in their health care Clinical quality is improved by informed guidance of all medical treatment, and service quality is improved by a streamlined and less involved process for the patient. Bodenheimer also shows that non-gatekeeping patients with multiple specialists must coordinate their own healthcare, negatively impacting that care’s quality. Gatekeeping allows GP’s help gather information can be gathered and shared by one person, rather than being investigated by all. This is an improvement in efficiency.

Efficiency is a measure of both technical and allocative efficiency. It reflects how high the ratio of healthcare provided to cost input is, and whether those costs are being spent on the best inputs to maximise healthcare outcomes (Roberts, 2008). As explained earlier, gatekeeping results in patients being more likely to visit the correct specialist for their case, or potentially not at all, meaning that specialists are not engaged in tasks better suited to other general practitioners or primary care practitioners, thus improving allocative efficiency. (Bodenheimer & Grumbach, 2009; Schoen et al., 2007). In the non-gatekeeping system this is not the case. A lack of gating has resulted in an over investment in secondary and tertiary care (the top heavy dispersed model), and specialists acting as preferred physicians or extended caregivers (Bodenheimer & Grumbach, 2009). This is an inefficient practice, both regarding the investment in creating so many secondary and tertiary care providers, and the money and time spent engaging overqualified specialists to do work that could be completed by less specialised and less expensive primary care providers (Bodenheimer & Grumbach, 2009). It has been shown that a specialist acting as a principle physician costs 33% more for the non-gatekeeping than if they used a primary care provider (Bodenheimer & Grumbach, 2009). In this regard, the gatekeeping system is much more efficient than the non-gatekeeping system. The access issues with the gatekeeping system are reflected negatively in efficiency too. More points of contact and enforced patient contact can result in a lot of time being spent by GPs on regulatory activities or general check ups even if they are not necessary from the patient perspective, but the overall impact on quality and efficiency appears to be a net positive. (Bodenheimer & Grumbach, 2009).

Indeed, it appears that gatekeeping as a whole can be seen as a net positive. Although there are some negative aspects, largely regarding ease of access and long wait times, the positive effects outweigh these. Gatekeeping benefits from improved quality of care due to continuous primary care involvement and coordination, which directly improves the efficiency of the healthcare system. Without gatekeeping, these access issues are not as apparent, but the quality and efficiency of care are consistently found to be lacking as a general practitioner is able to provide needed patient history and pattern that specialists do not have the time to notice or see. This is due to a lack of coordination, and the decisions made by patients with free access to healthcare and limited knowledge of how best to use it. It becomes clear in this case that a gatekeeping system, although potentially not ideal and certainly having its detractors, is a significant improvement over a free and ungated system when one considers which best provides access, quality and efficiency.