Primary care gatekeeping and referrals: patient’s view on the family physician role
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Date
2020
Authors
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Publisher
Ivane Javakhishvili Tbilisi State University Press
Abstract
An adequate primary healthcare system substantially determines quality
of population health and effective spending of healthcare resources. The family
physician serving as a ‘gatekeeper’ can make judicious decisions about the appropriate
use of medical services. The goal of this study was to find out patients’
characteristics, preferences and behavior in regards to the role of the family physician as the gatekeeper in The Republic of Georgia. As part of a cross-sectional
quantitative study, respondents were interviewed using a structured questionnaire.
Majority of the respondents (53.7%, n=245) had a permanent family physician,
but were not satisfied with a level of family physician’s professionalism
(56.6%, n=258) and preferred self-referral to specialists (55%, n=253). Only 19.5%
(n=89) referred to specialists upon family physician’s advice who would coordinate
all services and 23% (n=103) have used both family physicians and self-referral.
Private health insurance companies were more interested in implementing
cost reducing mechanisms rather than the Social Service Agency (which is responsible
for Universal Health Care Program).
Study results demonstrated that attitudes of different demographic groups
of population towards the ways of referral to specialists differ from each other. A
certain part of patients preferred referring to family physicians who would coordinate
all required medical services and be a sole agent protecting their interests.
The study demonstrated that beneficiaries of the private health insurance prefer
referring to specialists through their family physicians. It is due to the fact that
private health insurance companies were more concerned with establishing cost
reduction mechanisms rather than the beneficiaries of UHCP. Such a mechanism
implies increasing a role of family physicians, i.e. the gatekeepers of the healthcare
system. The model of gatekeeper has more benefits in regards to response
to the patient’s needs, improvement of the medical service coordination and cost
reduction. Such approach fits the key primary health values more, it accentuates
the key role of family physicians in the process of treatment and the importance
of confidence in the patient- physician relationship as well as responsiveness to
the individual patient needs.
In order to widely implement the gatekeeper model within the UHCP, each
beneficiary should have a permanent family physician who would ensure continuous
and comprehensive medical service provision. It is advisable to raise the level
of skills of family physicians, to develop a continuous medical education, as the
highly skilled physicians will enjoy more confidence among patients that in turn
will increase the rate of referral to them.
According to our study some beneficiaries preferred their family physician
to co-ordinate their care and referral to specialists when needed, while others
preferred self-referral. Therefore, implementing a flexible voluntary model of
gatekeepers may be a recommended policy. The flexible voluntary model of gatekeepers
means that the UHCP should explicitly offer all options and encourage
their members to choose the option which fits their preferences: self-referral,
gatekeeping or coordinated care with self-referral.
A voluntary choice of the gatekeeper model is acceptable both for physicians and for patients since it has no negative effect on the relations between
physicians and patients, plus it is responsive to patients’ needs. It can be assumed
that implementing gatekeeping voluntarily will be acceptable to physicians, because
a possible detrimental effect on patient relations, will not exist in a voluntary
model. Furthermore, a voluntary choice increases even more a responsibility
of the family physician as he/she ensures provision of comprehensive medical
services, including having control over the course of treatment.
Description
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Keywords
Primary health care, family physician, referral to family physician
Citation
Economics and Business, №1, 2020, pp. 80-92