title: Does gatekeeping control costs for privately insured children? Findings from the 1996 medical expenditure panel survey.
abstract: OBJECTIVE
  Gatekeeping requirements were widely adopted by health insurers in an attempt to control costs in the mid-1990s, but empirical evidence demonstrating decreased health expenditures for children enrolled in such plans is lacking.
  
  
  METHODS
  We analyzed data from 3254 children with private health insurance sampled in the 1996 Medical Expenditure Panel Survey (MEPS) to compare total per capita health expenditures among gatekeeping versus indemnity plan enrollees. This sample represents 40.4 million privately insured American children. Total expenditures were defined as payments from all sources, including third-party and out-of-pocket payments, but excluding administrative costs. MEPS data are based on information provided by patients, health care providers, and hospitals. Gatekeeping plans included all children enrolled in health maintenance organizations or other plans requiring a primary care gatekeeper. All others were considered indemnity plan enrollees.
  
  
  RESULTS
  Mean total per capita annual expenditures for children in gatekeeping versus indemnity plans differed by <1% (887 dollars vs 881 dollars, respectively). Third-party payments by gatekeeping plans on behalf of their beneficiaries were 636 dollars versus 595 dollars by indemnity plans. Out-of-pocket payments were on average 62 dollars less for gatekeeping enrollees than for indemnity enrollees. After multivariate adjustment, mean per capita expenditures were approximately 4% lower for gatekeeping enrollees than for indemnity enrollees.
  
  
  CONCLUSIONS
  In 1996, total per capita annual health expenditures for children in gatekeeping plans were approximately 8 dollars less than for those in indemnity plans. These data indicate that gatekeeping is not an effective cost-containment method for children.
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Daniel
authors.initials: D
authors.lastname: Rabinowitz
authors.forename: Olveen
authors.initials: O
authors.lastname: Carrasquillo
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics*; D003363:Cost Control / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000191:economics*; D012017:Referral and Consultation / Q000706:statistics & numerical data*