Eisenberg J M
Ann Intern Med. 1985 Apr;102(4):537-43. doi: 10.7326/0003-4819-102-4-537.
To reduce health care costs, some third-party payers have enlisted primary care physicians as gatekeepers to medical care. In gatekeeper systems, primary care physicians must approve all care provided to their patients. This approval is a condition of payment for the service, with the usual exception of true emergencies. The gatekeeper approach, sometimes called the case-manager plan, extends the responsibility of primary care physicians from coordination to control of medical care. However, for the plan to stimulate cost-effective medical care, it must overcome obstacles that threaten its ability to save money and provide high-quality medical care. If internists are to serve as gatekeepers, then medical educators must ensure that the necessary attitudes, skills, and knowledge are taught to students of internal medicine.
为降低医疗成本，一些第三方支付机构已将初级保健医生列为医疗服务的把关人。在把关人体系中，初级保健医生必须批准为其患者提供的所有医疗服务。这种批准是服务付费的一个条件，真正的紧急情况通常除外。把关人模式，有时也称为病例管理计划，将初级保健医生的职责从医疗协调扩展到医疗控制。然而，为使该计划能促进具有成本效益的医疗服务，它必须克服那些可能威胁其省钱能力和提供高质量医疗服务能力的障碍。如果内科医生要担任把关人，那么医学教育工作者必须确保向内科专业的学生传授必要的态度、技能和知识。
