Ntais Christos, Kontodimopoulos Nikolaos, Talias Michael A
Healthcare Management Program, School of Economics & Management, Open University of Cyprus, Nicosia 2220, Cyprus;
Department of Economics and Sustainable Development, Harokopio University, 17676 Athens, Greece;
J Mark Access Health Policy. 2024 Dec 6;12(4):378-387. doi: 10.3390/jmahp12040029. eCollection 2024 Dec.
As early as 1978, the World Health Organization set primary healthcare as the basis on which health systems should be built worldwide. However, the health systems of the different countries show considerable variations in terms of the implementation of gatekeeping from primary to secondary healthcare and direct access to specialists and hospital care. This literature review attempts to present the gatekeeping system with references to the UK, Sweden, the Netherlands, and Germany compared to the situation in Greece, where no gatekeeping system exists. Particular emphasis is placed on the impact of gatekeeping on the healthcare system's efficiency, equity of access, and the quality of the services provided. Evidence on the effects of gatekeeping is conflicting or limited by the low internal validity. Making the right gatekeeping implementation decisions is difficult in the absence of data. High-quality research studies on health outcomes, clinical efficacy, cost-effectiveness, quality of life, healthcare quality, utilisation of healthcare services, the burden in the healthcare system, and the opinions of patients, physicians, and policymakers are all necessary for developing policy.
早在1978年，世界卫生组织就将初级卫生保健确定为全球卫生系统应建立的基础。然而，不同国家的卫生系统在从初级卫生保健到二级卫生保健的守门制度实施以及直接获得专科医生和医院护理方面存在很大差异。本综述试图介绍英国、瑞典、荷兰和德国的守门制度，并与希腊不存在守门制度的情况进行比较。特别强调守门制度对卫生系统效率、公平可及性以及所提供服务质量的影响。关于守门制度效果的证据相互矛盾，或因内部效度低而受到限制。在缺乏数据的情况下，很难做出正确的守门制度实施决策。关于健康结果、临床疗效、成本效益、生活质量、医疗质量、医疗服务利用、卫生系统负担以及患者、医生和政策制定者意见的高质量研究对于制定政策都是必要的。
