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


  • Michel Naiditch

    () (IRDES institut for research and information in health economics)

  • Paul Dourgnon

    () (IRDES institut for research and information in health economics)


Study objective: Since January 2005 France is exploring a new scheme termed "preferred doctor" (médecin traitant) which can be considered as an innovative version of Gate Keeping in order to reduce the excess of postulated excess in health consumption, more especially access to specialist care. This paper describes the political process which lead to it's implementation, tries to relate some of the scheme specific features with it's results after one year implementation and tries to catch a glimpse for the next steps of the reform. Material and methods: In order to measure the scheme impact on the "patient treatment pathway" and on physician income, we used a sample of 7198 individual from the 2006 "French health, Health Care and Insurance Survey "(ESPS),"including health, socioeconomic and insurance status and through a set of questions relating to patient's understanding of the scheme and different data bases of the national sickness fund as well as different studies done by regulatory agencies. Results and discussion: First results after one year implementation show that most patients chose a preferred doctor, who in a vast majority happened to be their family doctor. A vast majority of patients also considered the scheme as mandatory. Impact on access to specialist care, as measured through self assessed unmet need for specialist care, appears not negligible, especially for the less well off and those not covered by a complementary insurance. In term of financial impact, the new constraints on access to ambulatory care seem to have been offset by rises in the fee schedules for the specialities which lost direct access We discuss why these short term weak outcomes are linked with a wicked system of the health system governance and to the political and professional context in which the scheme unfolded strongly and determined its structure and implementation pathway. On a more long range perspective, we analyse how the new scheme may nevertheless lead up to reinforced managed care reforms.

Suggested Citation

  • Michel Naiditch & Paul Dourgnon, 2009. "The preferred doctor scheme: A political reading of a French experiment of Gate-keeping," Working Papers DT22, IRDES institut for research and information in health economics, revised Mar 2009.
  • Handle: RePEc:irh:wpaper:dt22

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    Cited by:

    1. Or, Zeynep & Cases, Chantal & Lisac, Melanie & Vrangbæk, Karsten & Winblad, Ulrika & Bevan, Gwyn, 2010. "Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems," Health Economics, Policy and Law, Cambridge University Press, vol. 5(03), pages 269-293, July.
    2. Thierry Debrand & Christine Sorasith, 2010. "Bouclier sanitaire : choisir entre égalité et équité ? Une analyse à partir du modèle ARAMMIS," Working Papers DT32, IRDES institut for research and information in health economics, revised Jun 2010.
    3. Thierry Debrand & Nicolas Sirven, 2009. "What are the Motivations of Pathways to Retirement in Europe: Individual, Familial, Professional Situation or Social Protection Systems?," Working Papers DT28, IRDES institut for research and information in health economics, revised Oct 2009.
    4. repec:dau:papers:123456789/12227 is not listed on IDEAS
    5. Mousquès, Julien & Bourgueil, Yann & Le Fur, Philippe & Yilmaz, Engin, 2010. "Effect of a French experiment of team work between general practitioners and nurses on efficacy and cost of type 2 diabetes patients care," Health Policy, Elsevier, vol. 98(2-3), pages 131-143, December.
    6. Dourgnon, Paul, 2013. "Evaluation des politiques publiques et inégalités sociales d'accès aux services de santé," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/12221 edited by Wittwer, Jérôme.
    7. repec:dau:papers:123456789/14979 is not listed on IDEAS
    8. Groenewegen, Peter P. & Dourgnon, Paul & Greß, Stefan & Jurgutis, Arnoldas & Willems, Sara, 2013. "Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries," Health Policy, Elsevier, vol. 113(1), pages 170-179.
    9. Marie Ferrua & Claude Sicotte & Benoît Lalloué & Etienne Minvielle, 2016. "Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care?," Post-Print hal-01432934, HAL.
    10. Guillaume Chevillard & Julien Mousquès & Véronique Lucas-Gabrielli & Yann Bourgueil & Stéphane Rican & Gérard Salem, 2013. "Maisons et pôles de santé : places et impacts dans les dynamiques territoriales d'offre de soins en France," Working Papers DT57, IRDES institut for research and information in health economics, revised Nov 2013.
    11. Thierry Debrand & Christine Sorasith, 2010. "Out-of-Pocket Maximum Rules under a Compulsatory Health Care Insurance Scheme: A Choice between Equality and Equity," Working Papers DT34, IRDES institut for research and information in health economics, revised Nov 2010.

    More about this item


    Managed Care; Gate keeping; health care services utilization; unmet needs.;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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