Gatekeeping or Provider Choice for Sustainable Health Systems? A Literature Review on Their Impact on Efficiency, Access, and Quality of Services.

Q2 Medicine
Journal of market access & health policy Pub Date : 2024-12-06 eCollection Date: 2024-12-01 DOI:10.3390/jmahp12040029
Christos Ntais, Nikolaos Kontodimopoulos, Michael A Talias
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引用次数: 0

Abstract

As early as 1978, the World Health Organization set primary healthcare as the basis on which health systems should be built worldwide. However, the health systems of the different countries show considerable variations in terms of the implementation of gatekeeping from primary to secondary healthcare and direct access to specialists and hospital care. This literature review attempts to present the gatekeeping system with references to the UK, Sweden, the Netherlands, and Germany compared to the situation in Greece, where no gatekeeping system exists. Particular emphasis is placed on the impact of gatekeeping on the healthcare system's efficiency, equity of access, and the quality of the services provided. Evidence on the effects of gatekeeping is conflicting or limited by the low internal validity. Making the right gatekeeping implementation decisions is difficult in the absence of data. High-quality research studies on health outcomes, clinical efficacy, cost-effectiveness, quality of life, healthcare quality, utilisation of healthcare services, the burden in the healthcare system, and the opinions of patients, physicians, and policymakers are all necessary for developing policy.

可持续卫生系统的把关还是提供者选择?它们对服务效率、可及性和质量影响的文献综述。
早在1978年,世界卫生组织就将初级卫生保健作为建立世界卫生系统的基础。然而,不同国家的卫生系统在执行从初级到二级卫生保健的把关和直接获得专家和医院护理方面表现出相当大的差异。这篇文献综述试图以英国、瑞典、荷兰和德国的守门人制度为参照,与没有守门人制度的希腊的情况进行比较。特别强调把关对医疗保健系统的效率、公平获取和所提供服务质量的影响。把关效应的证据相互矛盾或受到内部效度低的限制。在缺乏数据的情况下,很难做出正确的把关实施决策。对健康结果、临床疗效、成本效益、生活质量、医疗保健质量、医疗保健服务的利用、医疗保健系统的负担以及患者、医生和决策者的意见进行高质量的研究,对于制定政策都是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
0.00%
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审稿时长
14 weeks
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