title: Implementing a gatekeeper system to strengthen primary care in Egypt: pilot study.
abstract: Overuse of hospital outpatient clinics in Egypt, due to lack of an effective gatekeeper system, has threatened the sustainability of improved primary care services. In this pilot project in Menoufia in the Nile delta region, the price of direct hospital outpatient visits was increased, encouraging patients to attend primary care clinics first. As a result, direct hospital outpatient utilization decreased by 63% in the project area compared with a 4% increase in a control district. The majority of this reduction was accounted for by patients attending either public primary care clinics or private clinics. Increasing the price of direct hospital outpatient visits was an effective way to establish a gatekeeper role for family health clinics.
authors.affiliation: Medical School, Australian National University, Canberra, Australia. tom.ward@magdalen.oxon.org
authors.forename: T R
authors.initials: TR
authors.lastname: Ward
mesh_terms: D004180:Direct Service Costs / Q000706:statistics & numerical data; D004534:Egypt; D005382:Financing, Personal; D018166:Health Care Reform / Q000458:organization & administration*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration; D017721:Hospital Costs / Q000706:statistics & numerical data; D006779:Hospitals, Public; D006801:Humans; D008389:Marketing of Health Services; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration