Archives of Hellenic Medicine

Last update:

19-Mar-2025

Arch Hellen Med, 42(3), May-June 2025, 323-329

REVIEW

Gatekeeping or direct access to specialized physicians for better efficiency, equity and patient satisfaction?
A literature review

C. Leonard,¹ C. Ntais,¹ J. Fanourgiakis,² N. Kontodimopoulos^1,3
¹Program of Healthcare Management, School of Economics and Management, Open University of Cyprus, Nicosia, Cyprus,
²Department of Management Science and Technology, Hellenic Mediterranean University, Agios Nikolaos, Crete,
³Department of Health Economics, Medical School, National and Kapodistrian University of Athens, Athens, Greece

Ηealth systems in different countries vary considerably in terms of how specialized care is accessed. Thus, some have a referral or gatekeeping mechanism to direct patients from primary to secondary care, while others allow direct access to specialists and hospital care. This review examines the implementation of the gatekeeping system in relation to its effect on (a) cost and efficiency of health systems, (b) equity of access, and (c) quality of care and patient satisfaction. International experience showed that gatekeeping is generally associated with reduced costs and increased efficiency for health systems, while direct access provides higher satisfaction to patients due to the freedom they are given to choose and directly access specialized care, but may be associated with higher costs and inequalities. Finally, the quality of health care appears to be associated with the effectiveness of the services, rather than with the way in which access to the health system is achieved.

Key words: Equity of access, Gatekeeping system, Health system efficiency, Patient satisfaction, Primary health care.