The Gatekeeper Model: patient’s view on the role of the family physician

Abstract

Background. 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. Objectives. 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. Materials and Methods. As part of a cross-sectional quantitative study, respondents were interviewed using a structured questionnaire. Results. 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). Conclusions. It is appropriate to share private health insurance experiences for developing a model of gatekeeper in the UHCP. In order to improve a family physician institute and increase confidence in it, it is recommended to raise the level of family physicians’ skills of relations with patients as it has a significant effect on the patient preferences. It is advisable to develop a flexible and voluntary gatekeeper model which will better suit the needs of both patients and physicians.