ArticleJournal of epidemiology and community health2006
Economic efficiency of gate-keeping compared with fee for service plans: a Swiss example.
Article in Journal of epidemiology and community health, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 62 citations in OpenAlex.
- Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Pooled it
- The effects of gatekeeping: a systematic review of the literature.Scandinavian journal of primary health care · 2011Pooled it
- Should the Mandatory Health Referral System be Implemented in Türkiye? A Perspective from a Tertiary Pulmonology Hospital.Thoracic research and practice · 2026Article
- Building paths to healthcare: an explorative qualitative study among undocumented mothers experiencing maternal and infant healthcare access in Switzerland.BMJ public health · 2026Article
- Gatekeeping or Provider Choice for Sustainable Health Systems? A Literature Review on Their Impact on Efficiency, Access, and Quality of Services.Journal of market access & health policy · 2024Review
- Toward a universal definition of provider-patient attachment in primary care.Canadian family physician Medecin de famille canadien · 2024Review
- Ontario family physicians' perspectives about their scope of practice: what is it, what drives it and how does it change?BMC primary care · 2022Article
- Characteristics and health care costs in patients with a diagnostic imaging for low back pain in Switzerland.The European journal of health economics : HEPAC : health economics in prevention and care · 2022Article
- Cost containment by peer prior authorization program for second line treatment in patients with retinal disease.Israel journal of health policy research · 2021Article
- Going beyond the mean: economic benefits of myocardial infarction secondary prevention.BMC health services research · 2020Article
- The effects of gatekeeping on the quality of primary care in Guangdong Province, China: a cross-sectional study using primary care assessment tool-adult edition.BMC family practice · 2019Article
- Article
- Factors influencing government insurance scheme beneficiary acceptance of the gatekeeper policy: a cross-sectional study in Wuhan, China.BMC health services research · 2018Article
- Gatekeeping and the utilization of community health services in Shenzhen, China: A cross-sectional study.Medicine · 2017Article
- Effects of Integrated Care on Disease-Related Hospitalisation and Healthcare Costs in Patients with Diabetes, Cardiovascular Diseases and Respiratory Illnesses: A Propensity-Matched Cohort Study in Switzerland.International journal of integrated care · 2016Article
- Article
- Integrated care organizations in Switzerland.International journal of integrated care · 2011Article
- Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system.BMC public health · 2007Article
- An empirical investigation of the efficiency effects of integrated care models in Switzerland.International journal of integrated careArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
objectiveThe impact of isolated gate-keeping on health care costs remains unclear. The aim of this study was to assess to what extent lower costs in a gate-keeping plan compared with a fee for service plan were attributable to more efficient resource management, or explained by risk selection.
designYear 2000 costs to the Swiss statutory sick funds and potentially relevant covariates were assessed retrospectively from beneficiaries participating in an observational study, their primary care physicians, and insurance companies. To adjust for case mix, two-part regression models of health care costs were fitted, consisting of logistic models of any costs occurring, and of generalised linear models of the amount of costs in persons with non-zero costs. Complementary data sources were used to identify selection effects.
settingA gate-keeping plan introduced in 1997 and a fee for service plan, in Aarau, Switzerland.
participantsOf each plan, 905 randomly selected adult beneficiaries were invited. The overall participation rate was 39%, but was unevenly distributed between plans. MAIN
resultsThe characteristics of gate-keeping and fee for service beneficiaries were largely similar. Unadjusted total costs per person were Sw fr 231 (8%) lower in the gate-keeping group. After multivariate adjustment, the estimated cost savings achieved by replacing fee for service based health insurance with gate-keeping in the source population amounted to Sw fr 403-517 (15%-19%) per person. Some selection effects were detected but did not substantially influence this result. An impact of non-detected selection effects cannot be ruled out.
conclusionsThis study hints at substantial cost savings through gate-keeping that are not attributable to mere risk selection.
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