Gatekeeping – Open Door to Effective Medical Care Utilisation?

Eva Hromadkova

CERGE-EI Working Papers from The Center for Economic Research and Graduate Education - Economics Institute, Prague

Abstract: We assess the ability of health insurance plans with gatekeeping restrictions to control the utilization of medical care through their inuence on the choice of the initial provider. Empirical results are based on the individuallevel utilization panel data from 2001-2006 Medical Expenditure Panel Survey. We nd only small dierences between the initial provider chosen by individuals enrolled in gatekeeping and non-gatekeeping plans. This, together with the fact that within gatekeeping plans, 21 percent of patients self-refer to specialists, imply that the intended cost-containment eect of gatekeeping, namely restricting the utilization of specialty care, is surprisingly weak.

Keywords: Health insurance; gatekeeping; health care utilization; episodic demand model; initial provider. (search for similar items in EconPapers)
JEL-codes: I11 I19 (search for similar items in EconPapers)
Date: 2009-11
New Economics Papers: this item is included in nep-hea and nep-ias
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