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Research Article
Gatekeeping versus direct-access when patient information matters
Article first published online: 18 JUN 2009
DOI: 10.1002/hec.1506
Copyright © 2009 John Wiley & Sons, Ltd.
1099-1050/asset/cover.gif?v=1&s=af8abe1b1dd6990bc2f6af06e451153b7d74332a "Health Economics")
Additional Information
How to Cite
González, P. (2010), Gatekeeping versus direct-access when patient information matters. Health Economics, 19: 730–754. doi: 10.1002/hec.1506
Publication History
- Issue published online: 11 MAY 2010
- Article first published online: 18 JUN 2009
- Manuscript Accepted: 29 APR 2009
- Manuscript Revised: 15 MAR 2009
- Manuscript Received: 30 JAN 2008
- Abstract
- References
- Cited By
Keywords:
- general practice;
- moral hazard;
- incentives;
- patient self-health information;
- patient pressure;
- referrals
Abstract
We develop a principal-agent model in which the health authority acts as a principal for both a patient and a general practitioner (GP). The goal of the paper is to weigh the merits of gatekeeping versus non-gatekeeping approaches to health care when patient self-health information and patient pressure on GPs to provide referrals for specialized care are considered. We find that, when GPs incentives matter, a non-gatekeeping system is preferable only when (i) patient pressure to refer is sufficiently high and (ii) the quality of the patient's self-health information is neither highly inaccurate (in which case the patient's self-referral will be very inefficient) nor highly accurate (in which case the GP's agency problem will be very costly). Copyright © 2009 John Wiley & Sons, Ltd.