Primary care in the United States - Primary care gatekeeping and referrals: effective filter or failed experiment?
Primary care in the United States - Primary care gatekeeping and referrals: effective filter or failed experiment?
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DOI：
10.1136/bmj.326.7391.692
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发表时间：
2003-03-29
影响因子：
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通讯作者：
Forrest, CB
中科院分区：
文献类型：
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作者：
Forrest, CB
在过去的几十年里，初级保健医生作为专家和其他医疗资源的看门人的使用——在美国被认为是一种管理式医疗创新——已经激增。它的引入伴随着一项政府赞助的关于初级保健转诊的研究方案（方框1）。这些研究的发现可能会为英国国民健康保险制度如何塑造全科医生的把关功能提供见解。本文讨论了看门人的概念，对比了美国和英国的专家转诊过程，考察了看门人影响资源分配的机制，并讨论了将看门人与财政激励和利用审查联系起来的效果。
The use of primary care physicians as gatekeepers to specialists and other medical resources—considered to be a managed care innovation in the United States—has proliferated during the past few decades. Its introduction has been accompanied by a government sponsored programme of research into referrals from primary care (box 1). Findings from these studies may offer insights into how the UK's NHS could shape the gatekeeping function of general practitioners. This article discusses the concept of gatekeeping, contrasts the processes of referral to specialists in the United States and the United Kingdom, examines the mechanisms by which gatekeeping influences resource allocation, and discusses the effects of linking gatekeeping with financial incentives and utilisation review.