Gatekeeping Revisited — Protecting Patients from Overtreatment

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Abstract
Over 90 percent of health maintenance organizations (HMOs) use primary care physicians as gatekeepers,1 whose role is to authorize access to specialty, emergency, and hospital care and to diagnostic tests. Gatekeeping has come to imply the medically limited and bureaucratic function of opening or closing the gate to high-cost medical services. This simplistic view of gatekeeping is controversial,2 , 4 both because of its menial connotation and because of the implication that the physician is the agent of the third-party payer, not the patient. The purpose of this paper is to reclaim the gatekeeper concept and to emphasize a more empowering role . . .

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