Physicians as gatekeepers: will they contribute to restrict disability benefits?

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Abstract
To study how general practitioners (GPs), specialists, and National Insurance Administration (NIA) medical consultants reacted to the narrowed eligibility criteria for disability benefits in Norway from 1991. Records of first-time applicants for disability benefits from the first quarters of 1990 and 1993 were analysed for proposals from the physicians in relation to the decision. Two Norwegian counties, Ostfold and Møre and Romsdal. 668 applicants--half the granted cases, and all the refused ones. The number of applicants fell by 39% from 1990 to 1993 and the refusal frequency increased from 8 to 21%. Nevertheless, GPs recommended refusal to about the same extent as before, 8-9% of all cases, with probably a minor fall from 52 to 42% of the refused ones (p = 0.19). Specialists did not recommend more refusals than the GPs. Cases evaluated by the NIA medical consultants increased from 29 to 41%, and their concordance with the patients' GPs seemed to be approximately 50%. GPs did not give more detailed medical descriptions in 1993 than in 1990, and discussed eligibility criteria but slightly more comprehensively. GPs are willing to act as gatekeepers for social insurance benefits for their patients, also when eligibility criteria become restricted.