JOHN M. EISENBERG Jr., M.D., M.B.A.
To reduce health care costs, some third-party payors have enlisted primary care physicians as gatekeepers to medical care. In gatekeeper systems, primary care physicians must approve all care provided to their patients. This approval is a condition of payment for the service, with the usual exception of true emergencies. The gatekeeper approach, sometimes called the case-manager plan, extends the responsibility of primary care physicians from coordination to control of medical care. However, for the plan to stimulate cost-effective medical care, it must overcome obstacles that threaten its ability to save money and provide high-quality medical care. If internists are to serve as gatekeepers, then medical educators must ensure that the necessary attitudes, skills, and knowledge are taught to students of internal medicine.
EISENBERG JM. The Internist as Gatekeeper: Preparing the General Internist for a New Role. Ann Intern Med. ;102:537–543. doi: 10.7326/0003-4819-102-4-537
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Published: Ann Intern Med. 1985;102(4):537-543.
Healthcare Delivery and Policy, Hospital Medicine.
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