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The Gatekeeper System (Healthcare)

In an HMO, the primary care physician acts as the "gatekeeper" to all higher levels of care that the patient may need. In theory, this means that the physician decides what is best for the patient and coordinates his or her care, while at the same times working to control costs and trying to ensure the delivery of care in the most efficient manner possible.

Thinking about this from both a third-party payer's and an administrator's perspectives, answer the following questions:

What are the advantages and disadvantages of using the gatekeeper system in terms of progressing through the levels of care?
Please select at least 2 advantages and 2 disadvantages for each group, and provide a rationale for your choices.

Solution Preview

One of the key advantages of the gatekeeper system from the third party payer's perspective, is the fact that this arrangement keeps the costs that are incurred and paid by the third party payers at a minimum, due to the fact that in this system the physician seeks to control costs in the most efficient means possible, while simultaneously ensuring that the patients receive the care that they need. It is quite obvious that the lower the healthcare costs, the more beneficial it is to the third-party payer as well as the patient. Another advantage is the fact that this system will essentially mean that higher levels of care will only be utilized ...

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