The Effects of Elimination of Gate-Keeping on Tertiary Care and the Social Insurance System

Abstract

The aim was to investigate the effects of elimination of gatekeeping on a university hospital and Social Insurance Institute (SII). Electronic records of 2006-2007 were analyzed. The mean outpatient visits was 273.8±69.9 before the gate-keeping elimination, it was 471.8±114.7 after the gate-keeping elimination (p<0.001). The increased rate of visits were in the department of cardiology (95.4%) followed by respiratory medicine (33.3%), orthopedics (22.6%), neurology (16.1%) and gynecology (11.4%). Also the most frequent diagnoses changed in these departments. The most frequent diagnoses before and after elimination were as follows; hypertension in comparison to anxiety disorders after elimination in cardiology, chronic obstructive lung disease compared to myalgia in respiratory medicine, fracture follow up compared to joint pain in orthopaedics, epilepsy compared to dizziness in neurology and infertility compared to vaginitis in gynecology. SII has paid 10.67 fold higher dues after elimination for these 7 departments and diagnoses. Consequently; elimination of the gate-keeping can easily be applied to tertiary care and can increase health expenditures.

Keywords

• Gate-keeping, university hospital, health expenditures

The Effects of Elimination of Gate-Keeping on Tertiary Care and the Social Insurance System

Öz

Kaynakça

1. Timoty G. Ferris, MD, MPH, Yuchiao Chang, PHD, David Blumen- tal, MD, MPP, And Steven D. Pearson MD. Leavıng gate-keeping behind-effects of opening access to specialists for adults in a health maintenance organization. N Engl J Med 2001; 345:1312-7. [CrossRef]
2. Moore DP, Richardson WC. Dose the primary-care gatekkeper control the cost of health care? Lessons from the SAFECO expe- rience. N Engl J Med 1983;309:1400-4.
3. Franks P, Clancy CM, Nutting PA. Gate-keeping revisited – protect- ing patients from overtreatment. N Engl J Med 1992;327:424-9
4. Forrest CB. Primary care in the United State: Primary care gate- keeping and referrals: effective filter or failed experiment? BMJ 2003;326;692-5.
5. Martin DP, Diehr P, Price KF, Richardson WC. Effect of a gate- keeper plan on health services use and charges: a randomized trial. Am J Public Health 1989;79:1628-32.
6. Merican MI, bin Yon R. Health care reform and changes: the Malaysian experience Asia-Pacific Journal of Public Health. 2002;14:17-22.
7. Anderson GF, Hurst J, Hussey PS, Jee-Hughes M. Health spend- ing and outcomes: trends in OECD countries, 1960-1998. Health Affairs 2000;19:150-7.
8. Boerma WG, van der Zee J, Fleming DM. Service profiles of gen- eral practitioners in Europe, European GP Task Profile Study. Br J Gen Pract 1997;47:481-6.

9. Institute for Policy Innovation (IPI). The dangers of undermin- ing patient choice: lessons from Europe and Canada. October 2006;35-7.
10. Kurt R. Brekke, Robert Nuschele, Odd Rune Straum. Gate-keep- ing in health care. Journal of Health Economics. 2007;149–70.
11. Sağlık hizmetlerinin sosyalleştirilmesi hakkında kanun (no: 224). Official gazette, issue date: 01.12.1961, no.10705
12. Ersoy F, Sarp N. Restructuring the primary health care services and changing profile of family physicians in Turkey. Fam Pract 1998;15:576-8.
13. Grembowski DE, Martin D, Diehr P, Patrick DL, Williams B, Novak L et al. Managed care Access to specialists, and outcomes among primary care patients with pain Healt Serv Res. 2003;38:1-19.
14. Grembowski DE, Martin D, Patrick DL, et al. Maged care, Ac- cess to mental health specialist, and outcomes among primary care patients with depressive symptoms. JGen Intern Med 2002;17:258-69
15. Schwenkglenks M, Preiswerk G, Lehner R, Weber F, Szucs TD Economic efficiency of gate-keeping compared with fee for service plans: a Swiss example. J Epidemiol Community Health 2006;60:24-30.
16. Ee-Ming Khoo, Kidd MR. Primary health care and general prac- tice a comparison between Australia and Malaysia. Asia-Pacific Journal of Public Health 2002;14:59-63.