title: Are the serious problems in cancer survival partly rooted in gatekeeper principles? An ecologic study.
abstract: BACKGROUND
  It is puzzling to note that British and Danish citizens have a poorer cancer prognosis than citizens from other countries, and this study hypothesises that their low cancer survival could be partly rooted in the gatekeeper function undertaken by general practice in these two countries.
  
  
  OBJECTIVE
  To test the association between principles of gatekeeper systems and cancer survival.
  
  
  METHODS
  An ecologic study with data from EUROCARE-4 and primary care structure.
  
  
  METHODS
  This hypothesis was tested in an ecologic study on the association between three principles of gatekeeper systems and cancer survival in 19 European countries for which valid and full data were available.
  
  
  RESULTS
  It was found that healthcare systems with a gatekeeper system do have a significantly lower 1-year relative cancer survival than systems without such gatekeeper functions.
  
  
  CONCLUSIONS
  The possible mechanisms behind this finding are discussed, and while all the positive aspects of gatekeeping are recognised, it is strongly recommended that further research be conducted to confirm or reject the study hypothesis on this possible serious adverse effect of gatekeeping.
authors.affiliation: The Research Unit for General Practice, Aarhus University, Aarhus, Denmark. p.vedsted@alm.au.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.forename: Frede
authors.initials: F
authors.lastname: Olesen
mesh_terms: D055088:Early Detection of Cancer / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D020793:Gatekeeping / Q000706:statistics & numerical data*; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality*; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D014850:Waiting Lists