Gatekeeping versus direct-access when patient information matters.
Gatekeeping versus direct-access when patient information matters.
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当患者信息很重要时，守门与直接访问。
作者：
Paula González
我们开发了一个委托代理模型，其中卫生当局作为一个主要的病人和全科医生（GP）。本文的目的是权衡的优势，守门与非守门的方法，以医疗保健时，病人的自我健康信息和病人的压力，全科医生提供转介专业护理。我们发现，当全科医生的激励措施很重要时，只有当（i）患者转诊压力足够高，（ii）患者自我健康信息的质量既不高度不准确（在这种情况下，患者的自我转诊效率将非常低），也不高度准确（在这种情况下，全科医生的代理问题将非常昂贵）时，非守门系统才是可取的。
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).