Gatekeeping and provider choice in OECD healthcare systems

Gatekeeping and provider choice have become central in health policymaking within the last two decades. This article contributes to the debates in two ways: first, it provides an extended review of evidence on the impact of gatekeeping and provider choice on efficiency, costs, quality, equality and...

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Bibliographic Details
Published in:Current sociology 2012-07, Vol.60 (4), p.489-505
Main Authors: Reibling, Nadine, Wendt, Claus
Format: Article
Language:English
Subjects:
Access
Access to health care
Choices
Empowerment
Equality
Health Behavior
Health care
Health care policy
Health Care Services
Health expenditure
Health services
Industrialized nations
Managed Care Services
OECD
Policy Making
Quality control
Reform
Regulation
Studies
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Summary:Gatekeeping and provider choice have become central in health policymaking within the last two decades. This article contributes to the debates in two ways: first, it provides an extended review of evidence on the impact of gatekeeping and provider choice on efficiency, costs, quality, equality and patient empowerment; and second, it empirically analyses regulations and identifies common trends in healthcare reforms in OECD countries since 1990. More than half of the countries analysed have established gatekeeping systems, while a smaller number provides free access to secondary care. The study discovers a trend towards strengthening gatekeeping regulations within free access countries. Free choice of provider is the standard in the OECD, where only a small number of countries restrict provider choice. The article identifies a diverging trend of reforms, with some traditionally restrictive countries offering more provider choice and other countries limiting the choice of providers as a result of managed care reforms.
ISSN:0011-3921
1461-7064
DOI:10.1177/0011392112438333