The preferred doctor scheme: A political reading of a French experiment of Gate-keeping

Abstract Objectives Since 2006 France experiences an innovative version of Gate-keeping which aims at regulating access to outpatient specialist care. We describe the reform's initial objectives, the political pathway which lead to the implementation of a reshaped reform and discuss the first o...

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Bibliographic Details
Published in:Health policy (Amsterdam) 2010-02, Vol.94 (2), p.129-134
Main Authors: Dourgnon, Paul, Naiditch, Michel
Format: Article
Language:English
Subjects:
Access to health care
Compliance
Data Collection
Doctors
Evaluation studies
France
Gate-keeping
Gatekeeping - organization & administration
Health
Health administration
Health Care Reform
Health care reform Gate-keeping Evaluation studies
Health insurance
Health policy
Humans
Internal Medicine
Patients
Physicians
Politics
Preferences
Referral and Consultation
Reforms
Regulation
Specialists
Unmet needs
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Summary:Abstract Objectives Since 2006 France experiences an innovative version of Gate-keeping which aims at regulating access to outpatient specialist care. We describe the reform's initial objectives, the political pathway which lead to the implementation of a reshaped reform and discuss the first outcomes after 1 year implementation. In the conclusion, we try to catch a glimpse for future steps of the reform. Methods In order to observe the implantation and impact on the reform, we used national sickness fund databases and a sample of 7198 individuals from the 2006 French Health, Health Care and Insurance Survey (ESPS), including health, socio-economic and insurance status, questions relating to patient's understanding and compliance with the scheme, self-assessed unmet specialist needs since the reform. Results and discussion 2006 results show that 94% chose a preferred doctor, in a vast majority their family doctor. Impact on access to specialist care appears significant for the less well off and those not covered by a complementary insurance. From the specialist's side, new constraints on access to care seem to have been offset by rises in fee schedules. Conclusion Notwithstanding disappointing short terms results, the new scheme may however lead up to reinforced managed care reforms.
ISSN:0168-8510
1872-6054
DOI:10.1016/j.healthpol.2009.09.001