The impact of gatekeeping on physician practice patterns

Abstract

This study is the first study to examine the effectiveness of gatekeeping performed by cardiovascular surgeons. It is designed to evaluate the effectiveness of gatekeeping using social network analysis as a guiding theoretical framework and the concept of gatekeeping. Data are collected from 447 Medicare patients who underwent coronary artery bypass graft (CABG) surgery from January 1, 1993 to January 1995. The study uses social network theory to conceptualize and generate hypotheses concerning the effects of cardiovascular surgeons acting as gatekeepers in providing care over an extended period of time. Also, the study explores the effect of patients\u27 characteristics on gatekeeping. Time series analyses and SEM analyses are utilized to examine the effectiveness of gatekeeping. This study finds that the effectiveness of gatekeeping increases over time. Gatekeeping results in a reduction in resource utilization and hospital costs whereas physician charges increase over time. Gatekeeping appears to have weaker effects on controlling resources and costs for older, female, and sicker patients. Finally, there are minor differences in the way that cardiovascular surgeons perform the gatekeeping function