Gatekeeping Essay

In the healthcare system, Gatekeeping implies that access to specialists is restricted and can only approach upon referral from the General Practitioners so that quality is enhanced and exploitation is reduced (Weynants, 2015). When Amber experiences a sharp pain, she could not just approach the specialists to treat her but had to go the GP to get the referral which shows that Amber is subject to gatekeeping and her GP is acting as the gatekeeper. On the other hand, when Bradley experiences the same problem, he could directly go to the specialist without any referral and this shows that Bradley is not subjected to any gatekeeping. Another reason we could say Amber is subjected to gatekeeping is that she lives in NZ where the gatekeeping mechanism

To decide which is beneficial, it is important to know what makes a good healthcare system. There are 3 elements needed to be considered to make a good healthcare system which are access, quality, and efficiency. Access is defined as being able to the use the service when needed (Roberts, Hsiao, Berman and Reich, 2008). The advantage of the NZ healthcare system which uses gatekeeping is that it provides access to a larger range of people. As GPs are community-based, they are generally easier to access. This could be seen as 72% of the New Zealand adults in 2013 were able to get the appointment on the same or next day when they were sick. But even then cost is the main barrier to access the primary care in New Zealand as 21% of the NZ adults experienced cost as a barrier to access healthcare in 2013. This shows that even though gatekeeping provides a wider access to healthcare for 72%, there is still a significant amount of people where cost is still a barrier (Mossialos et al.,

This can be seen as only 48% of USA adults in 2013 were able to get the appointment on the same or next day when they were sick. This shows being a specialist care-focused health care system can limit access to healthcare for 50% of USA adults which is a really a big disadvantage. This could be due to specialist care being really expensive which has been discussed in Bradley’s case. Also, if you are not insured then it gets really hard and almost impossible to be able to consult a specialist decreasing access to a range of people (Mossialos et al., 2016). Being a country with no gatekeeping, USA seems to have an advantage of having greater clinical quality of care as the patients can self-refer to specialists. This is because specialists are said to have more medical knowledge regarding their specialty and are able to manage conditions better than GPs (Bodenheimer & Grumbach, 2009). But on the other hand, specialists are very expensive and also less convenient for the poor so the direct access to the specialist may give rise to inequalities. This shows that approaching the specialist might be easier for the wealthy while it might decrease the service quality of care for the poor as it is less convenient for them. Also, service quality can be reduced due to long waiting times decreasing patient satisfaction (Greenfield et al., 2016). USA