Gatekeeping Revisited — Protecting Patients from Overtreatment

Abstract

Over 90 percent of health maintenance organizations (HMOs) use\nprimary care physicians as gatekeepers, whose role is to authorize access to\nspecialty, emergency, and hospital care and to diagnostic tests. Gatekeeping\nhas come to imply the medically limited and bureaucratic function of opening\nor closing the gate to high-cost medical services. This simplistic view of\ngatekeeping is controversial, both because of its menial connotation and\nbecause of the implication that the physician is the agent of the third-party\npayer, not the patient. The purpose of this paper is to reclaim the gatekeeper\nconcept and to emphasize a more empowering role of patient advocacy, that of\nprotecting patients from the detrimental effects of unnecessary medical\nservices.