title: Is the role as gatekeeper still feasible? A survey among Dutch general practitioners.
abstract: BACKGROUND
  In the 2012 International Health Policy Survey by the Commonwealth Fund, 57% of Dutch GPs indicated that Dutch patients receive too much health care. This is an unexpected finding, given the clear gatekeeper role of Dutch GPs and recent efforts strengthening this role.
  
  
  OBJECTIVE
  The study aims to explore where perceived overuse of care prevails and to identify factors associated with too much care at the entry point of Dutch health care.
  
  
  METHODS
  An American survey exploring perceptions of the amount of care among primary care providers was modified for relevance to the Dutch health system. We further included additional factors possibly related to overuse based on 12 interviews with Dutch GPs. The survey was sent to a random sample of 600 GPs.
  
  
  RESULTS
  Dutch GPs (N = 157; response rate 26.2%) indicated that patients receive (much) too much care in general hospitals, primary care, GP cooperatives as well as private clinics. The Dutch responding GPs showed a relatively demand-satisfying attitude, which contributed to the delivery of too much care, often leading to deviation from guidelines and professional norms. The increasing availability of diagnostic facilities was identified as an additional factor contributing to the provision of unnecessary care. Finally, funding gaps between primary care and hospitals impede cooperation and coordination, provoking unnecessary care.
  
  
  CONCLUSIONS
  Our results--most notably regarding the demand-satisfying attitude of responding GPs--call into question the classical view of the guidance and gatekeeper role of GPs in the Dutch health care system.
authors.affiliation: Celsus Academy for Sustainable Healthcare, Scientific Institute for Quality of Healthcare (IQ healthcare) and joost.wammes@radboudumc.nl.
authors.forename: Joost Johan Godert
authors.initials: JJ
authors.lastname: Wammes
authors.affiliation: Celsus Academy for Sustainable Healthcare.
authors.forename: Patrick Paulus Theodoor
authors.initials: PP
authors.lastname: Jeurissen
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare) and.
authors.forename: Lise Maria
authors.initials: LM
authors.lastname: Verhoef
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare) and.
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare) and.
authors.forename: Marjan J
authors.initials: MJ
authors.lastname: Faber
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003363:Cost Control; D003954:Diagnostic Services; D005260:Female; D020793:Gatekeeping; D058006:General Practice / Q000706:statistics & numerical data*; D006300:Health Services Misuse; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057240:Patient Preference; D010465:Perception; D010819:Physician's Role; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011795:Surveys and Questionnaires
keywords: Attitude of health personnel; GPs; physician’s practice patterns; primary care physicians; primary health care; referral and consultation.