title: Gatekeeping versus direct-access when patient information matters.
abstract: We develop a principal-agent model in which the health authority acts as a principal for both a patient and a general practitioner (GP). The goal of the paper is to weigh the merits of gatekeeping versus non-gatekeeping approaches to health care when patient self-health information and patient pressure on GPs to provide referrals for specialized care are considered. We find that, when GPs incentives matter, a non-gatekeeping system is preferable only when (i) patient pressure to refer is sufficiently high and (ii) the quality of the patient's self-health information is neither highly inaccurate (in which case the patient's self-referral will be very inefficient) nor highly accurate (in which case the GP's agency problem will be very costly).
authors.affiliation: Dpto. Economía, Métodos Cuantitativos e Historia Económica, Universidad Pablo de Olavide, Sevilla, Spain. pgonzalez@upo.es
authors.forename: Paula
authors.initials: P
authors.lastname: González
mesh_terms: D003363:Cost Control / Q000379:methods; D005194:Family Practice; D020793:Gatekeeping; D006297:Health Services Accessibility; D006801:Humans; D017060:Patient Satisfaction; D010816:Physician Incentive Plans; D010817:Physician-Patient Relations; D012017:Referral and Consultation