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Gatekeeping – Open Door to Effective Medical Care Utilisation?

Author

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  • Eva Hromadkova

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.

Suggested Citation

  • Eva Hromadkova, 2009. "Gatekeeping – Open Door to Effective Medical Care Utilisation?," CERGE-EI Working Papers wp400, The Center for Economic Research and Graduate Education - Economics Institute, Prague.
  • Handle: RePEc:cer:papers:wp400
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    File URL: http://www.cerge-ei.cz/pdf/wp/Wp400.pdf
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    References listed on IDEAS

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    5. Scott, Anthony, 2000. "Economics of general practice," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 22, pages 1175-1200 Elsevier.
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    More about this item

    Keywords

    Health insurance; gatekeeping; health care utilization; episodic demand model; initial provider.;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I19 - Health, Education, and Welfare - - Health - - - Other

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