Effect of a gatekeeper plan on health services use and charges: a randomized trial.

Martin, Diane P.; Diehr, Paula; Price, Kurt; Richardson, William C.

doi:10.2105/ajph.79.12.1628

Cited by 110 publications

(73 citation statements)

References 7 publications

(1 reference statement)

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“…fq G l (l = r 1 ; :::; r 2 ¡ 1); q G r 2 ; µ C2 ; q S r 2 ; q S l (l = r 2 + 1; :::; L); ®g (18) where ® is the actuarially fair premium de…ned by (17).…”

Section: Information Asymmetrymentioning

confidence: 99%

“…In practice, however, a substantial part of the e¢ciency gains achievable through a second-best optimal managed care plan of the form (18) may be due to the fact that consumers in conventional plans do not know where in the r 2 interval they are and, as a result, can only choose one type of provider in that interval. If they consistently choose S (that is, choose in-hospital specialty care), total costs are likely to be considerably higher than they would be if those below µ C2 would choose G. Indeed, studies of the reason why HMOs in the US are able to provide care at costs below those of conventional plans have pointed to less utilization of hospital services as an important part of the explanation.…”

Section: Proofmentioning

confidence: 99%

“…Furthermore, in cases where primary-care physicians have a role as gatekeepers (that is, a referral from a primary-care doctor is required for a patient to receive treatment by a specialist or in hospital), it has been found that gatekeepers who face …nancial risks when they refer (that is, who have to pay some of the cost of specialist and hospital care used by their patients) are less likely to refer to specialists (Martin et al, 1989;Hurley et al, 1991). Patients also appear to respond to demand-side incentives when making decisions with respect to specialist care.…”

Section: Introductionmentioning

confidence: 99%

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Information asymmetry, insurance, and the decision to hospitalize

Blomqvist

Léger

2005

Journal of Health Economics

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CIRANOLe CIRANO est un organisme sans but lucratif constitué en vertu de la Loi des compagnies du Québec. Résumé / AbstractÀ l'aide d'un modèle théorique dans lequel patients et médecins doivent choisir la quantité de service à utiliser ainsi que celui, de l'omnipraticien ou du spécialiste oeuvrant à l'hôpital, qui fournira ces services, nous analysons différents mécanismes d'incitation agissant sur l'offre et la demande. Nous étudions essentiellement deux modes d'organisation : le système conventionnel de rémunération à l'acte et le système de gestion intégrée des soins avec une rémunération per capita; à la fois en présence et en l'absence d'asymétrie d'information. Nous obtenons comme résultat qu'à certaines conditions plausibles, l'optimum de second-rang auquel mène le système de gestion intégrée est supérieur à celui que donne le système conventionnel de rémunération à l'acte qui répercute une partie des coûts sur l'utilisateur. In a theoretical model, we analyze the effects of various kinds of demand-and supply-side incentives in the context of a model in which patients

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“…fq G l (l = r 1 ; :::; r 2 ¡ 1); q G r 2 ; µ C2 ; q S r 2 ; q S l (l = r 2 + 1; :::; L); ®g (18) where ® is the actuarially fair premium de…ned by (17).…”

Section: Information Asymmetrymentioning

confidence: 99%

Section: Proofmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Information asymmetry, insurance, and the decision to hospitalize

Blomqvist

Léger

2005

Journal of Health Economics

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“…Sevkin gerekli olduğu durumlarda kişinin sağlık bilgileriyle birlikte doğru uzmanlık dalına ve doğru merkeze gitmesini sağlayarak, birinci basamağa göre daha yüksek maliyetli ikinci basamak sağlık hizmetlerinin daha etkili ve ekonomik biçimde kullanımını sağlar (9). Kapı tutuculuğunun uzman kullanımını ve hastaneye yatışı ve de yapılan tıbbi işlemleri azalttığı göste-rilmiştir (33,34). ABD'de uzmana ulaşım imkanı artıkça, sevk oranında artmaktadır.…”

Section: İllerunclassified

Evaluation Of Health Care Services In Erzurum Health Region Prior To The Application Of Family Medicine Practice

Üstü¹,

Uğurlu²,

Örnek³

et al. 2009

TUTFD

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ÖZETAmaç: Türkiye'de, sağlık hizmetlerinin verilmesinde başta insan kaynakları ve ulaşım sorunları olmak üzere çeşitli güçlüklerle karşılaşılmaktadır. Bu çalışmada ülkemizin sağlık göstergeleri açısından daha geri durumdaki doğu bölgelerindeki sağlık verilerinin incelenmesi ve tartışılması amaçlan-maktadır. Bulgular: Bölgede 2002 yılına göre pratisyen hekim sayısında %44, yardımcı sağlık personeli sayısında ise %65 artış sağlanmıştır. 2002 yılına göre yıllık başvuru sayısı 1.9'dan 4.5'e (%33'ü birinci basamak, %67'si ise ikinci basamak) yükselmiştir. Sevk oranı ise %20.2 'den %2.7'ye düşmüştür. Böl-ge geneli bebek tespit oranı %87, gebe tespit oranı ise %70'tir. DBT-1 aşı oranı ise %90'dır. Tüberküloz hasta insidansı yüz binde 14'tür. Bölge illerinde birinci basamak sağlık hizmetlerinde iyileşme mevcuttur. İkinci basamağa başvuru sıklığı ise halen yüksektir. Personel sayısındaki artışa rağmen aşılama başta olmak üzere birinci basamak sağlık hizmetlerinde hedefe ulaşmanın zaman alacağı gözlenmektedir.Sonuç: Hizmet entegrasyonunun sağlanması, sevk zincirinin tesisi ve sağlık düzeyi göstergelerinin artırılması açısından aile hekimliği uygulaması umut vermektedir.Anahtar Sözcükler: Türkiye, aile hekimliği uygulaması, birinci basamak sağlık hizmeti, Erzurum sağlık bölgesi, saha ziyaretleri ABSTRACT Objective: Turkey has problems starting with manpower shortage and transportation problems to deliver health care services. In this study, it is intended to investigate and discuss the data of the eastern region of Turkey which is trailing in health care indicators. Material and Methods:In this cross-sectional study, the health data gathered through periodical field studies in the Erzurum Health Field during 2002-2008 are compared.Results: In the region, compared to year 2002 data, a 44% increase in general practitioner number and 65% increase in supporting medical personnel number have been achieved. Compared to year 2002 data, application to the health organisation has increased from 1.9 to 4.5 (33% to primary level and 67% to secondary level). The referrals from local health clinics to hospitals have been reduced from 20.2% to 2.7%. In the region in general, recording of birth ratio is 87% and recording of pregnancy ratio is 70%. DBT-1 vaccination ratio is 90%. Tuberculosis ratio is 14 per hundred thousand. Health care services have improved in the cities of the region. Referral ratios to secondary level frequency is still high. Even though the number of personnel is increased, it is observed that, to reach the set targets, starting with innoculation, the primary level health care services will take time.Conclusion: Family medicine practice is promising for the integration of services, institution of referral chain system and improvement of health level indicators.Key Words: Turkey, family medicine practice, primary health care, Erzurum health region, field visits : 22.06.2009: 22.06. Accepted: 14.08.2009 Giriş Gelişmişlik düzeyi ne olursa olsun bugün ulusal sağlık sistemlerinin giderek artan taleplerle, kaynak kısıtl...

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“…Cost arguments aside, primary care gate-keeping provides an important filter to specialist care (4). Incentives and penalties for physicians acting as gatekeepers can reduce the cost of ambulatory services by limiting specialist visits (5).…”

Section: Introductionmentioning

confidence: 99%