Self-referral in a gatekeeping system: patients’ reasons for skipping the general-practitioner

Abstract

In the Netherlands general practitioners act as the gatekeepers at the primary level to the more specialized and more expensive secondary health-care. As a rule, patients are required to have a referral from their general practitioners to be able to utilize these services. Not all private insurance companies, however, require a referral letter from their customers before reimbursing them for their costs or do not always exert a control whether such referral indeed had taken place. A mail-questionnaire was targeted to a specific group of 2000 privately insured patients to find out the reasons of self-referral. The findings suggest that patients self-refer to a specialist for medical complaints for which they expect to end up at the specialist anyway as they consider these problems as specific for the specialist. Complaints of patients who first visit their general practitioners, however, might be considered as less typical to the specialist. Patients who are living in relatively highly urbanized areas, who are better educated, and who expect to achieve a better quality of communication at the consultation with the specialist, more commonly skip their GPs before visiting a specialist.

Lack of use for advice by parents results in increasing attendance to the paediatric emergency department

“…Our data support previous findings that patients often choose to attend the PED because of perceived convenience, particularly the location of the emergency department 4. In Tooting, the Walk-in Centre (WIC), where patients over the age of 2 years can be seen, is just opposite the entrance to the PED.…”

The role of socio-economic status in the decision making on diagnosis and treatment of oesophageal cancer in The Netherlands

“…In The Netherlands, general practitioners are the gatekeepers of the health care system, meaning that patients usually first consult the general practitioner for symptoms before being referred to a hospital (Kulu-Glasgow et al, 1998). In general, it is true that there is a low threshold and there are no economical barriers for patients to consult a general practitioner.…”

Rethinking primary care’s gatekeeper role

“…45 In France, the 2005 health financing reform law introduced a voluntary gatekeeping scheme termed "the preferred doctor," aiming at regulating access to outpatient specialist care and providing patients with financial incentives to see their preferred GP first rather than consult a specialist directly. [39][40][41][42][43][44][45][46][47] Although the scheme has shown disappointing short terms results, 39 it may have contributed to the reduction in the health system deficit. 47 Constraints on access to specialists were offset by rises in their fees.…”