In 1995–1997, David Blumenthal, M.D., Ph.D., and researchers at Massachusetts General Hospital, Boston, evaluated the impact of a major component of managed care—the use of a primary care physician as a gatekeeper to authorize all health services of HMO members.
Researchers collected health care claims data from the two years before and the two years after patients switched from a traditional indemnity plan without gatekeepers to an HMO. Researchers also conducted self-administered surveys of both patients and physicians.
This project was part of the Robert Wood Johnson Foundation (RWJF) national program Changes in Health Care Financing and Organization (HCFO).
Key Findings: Researchers reported the following findings in a Findings Brief available at the HCFO website.
- Primarily as a result of reduced use of specialists, gatekeeping resulted in lower costs during the first year. However, costs rose during the second year as patients became familiar with administrative requirements for obtaining specialist care. Second year costs were just below indemnity plan levels.
- The gatekeeping requirement appeared to improve continuity of care through the advice and oversight of specialty care provided by the primary care physician.
- HMO enrollees were less positive than indemnity plan subscribers about:
- Information provided by their primary care physician.
- The thoroughness of physical examinations.
- Their physician's personal interest, attention and amount of time with them.
- Although physicians were positive about cost control in the gatekeeping system, they felt that gatekeeping did not yield as much quality of care and satisfaction as the traditional indemnity plan did.
- Gatekeeping did not result in a significant increase in preventive health care measures such as number of Pap tests, mammograms and other screening procedures.
Changes in Health Care Financing and Organization Project Results
Individual project results from the RWJF national program, Changes in Health Care Financing and OrganizationRead the Program Results for Changes in Health Care Financing and Organization View all
Learn how to improve care transitions and prevent avoidable hospital readmissions, and pick up nursing and medical education con-ed credits.
Mildred Dalton Manning, the last surviving member of a group of U.S. Army and Navy nurses taken prisoner in the Philippines at the start of ...
Join the Commission on June 19, 2013 for a public meeting to raise awareness of how non-medical factors influence health and move public- an...
The reconvened Commission to Build a Healthier America will provide new guidance in two key areas: early childhood and healthy communities.
By “practicing” with medical simulation and by interacting with culturally diverse standardized patients, students and residents can develop...
The RWJF Roadmaps to Health Prize honors outstanding community partnerships which are helping people live healthier lives. The six winners w...
Cure Violence, formerly known as CeaseFire, is a national public health strategy that reduces gun shootings and killings.
A study finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with IOM report recommendation that “nurse practiti...
The strange pull of this series is its humanity, not its horrors.
Team members, grantees, and guests discuss breakthrough ideas that will allow us to move toward solving challenges in health care.
This is the agenda for the June 19, 2013 RWJF Commission to Build a Healthier America public meeting.
What does U.S. health care have in common with an exotic international bazaar? The prices at either one are almost never posted, whether for...