Gatekeeping — a system in which health plan enrollees choose a primary care physician (PCP) as a de-facto services utilization manager and consultant to make decisions regarding the need for specialty providers and services — is a term that is widely recognized within the context of managed health care. But how well the public understands both the objectives of gatekeeping and its effects on health care delivery, is not widely known. Thus, the question posed by David Blumenthal, M.D., chief of the Health Policy Research and Development Unit at Massachusetts General Hospital (MGH), and his colleagues was how does gatekeeping effect access to, quality of, and satisfaction with health care. Specifically, he examined the outcomes for employees of a large Massachusetts hospital who chose to join a health maintenance organization (HMO) that required the use of a PCP gatekeeper, rather than remaining in a similar plan without a gatekeeper.
