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 provider’s and a payer’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? Provide an example of each perspective.
What are at least 2 advantages and 2 disadvantages for each group? Provide a rationale for your choices.