Primary care gatekeeping, in which the goal of the primary care physician (PCP) is to reduce patient referrals to specialists and thereby reduce costs, is not an adequate system in which to practice medicine.
However, returning to the pre-managed care model of uncoordinated open access to specialists is a poor solution.
The primary care model should be retained, but PCPs should be transformed from gatekeepers into coordinators of care, in which the goal of the PCP is to integrate both primary and specialty care to improve quality.
Changes in the PCP's daily work process, as well as the referral and payment processes, need to be Implemented to reach this goal.
This model would eliminate the requirement that referrals to speciallsts be authorized by the primary care physician or managed care organization.
Financial incentives would be needed, eg, to encourage PCPs to provide management of complex cases and discourage both overreferral and underreferral to specialists.
Budgeting specialists should control excess costs that might be created by the elimination of the primary care gatekeeper.
Pilot projects are needed to test and refine this model of PCP as coordinator of care.
Mots-clés Pascal : Soin santé primaire, Médecin généraliste, Rôle professionnel, Coordination, Aspect politique, Concept, Programmation objectif, Homme, Facteur risque, Organisation santé
Mots-clés Pascal anglais : Primary health care, General practitioner, Occupational role, Coordination, Political aspect, Concept, Goal programming, Human, Risk factor, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0334785
Code Inist : 002B30A09. Création : 16/11/1999.