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March 25, 1998

Gatekeeping: Good or Bad, but Never Indifferent

JAMA. 1998;279(12):908-910. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325

To the Editor.—The data presented by Dr Halm and colleagues1 indicate that, from the respondents' perspective, gatekeeping had a negative effect on almost every aspect of care that was measured, including the patient-physician relationship, time with the patient, freedom in clinical decision making, and the ability to use resources appropriately (eg, the use of hospitalization, the use of specialists, and the choice of medication). In contrast, the only positive effects on clinical care that were reported were in the use of preventive services and the coordination of care. How, then, do the authors conclude that "nearly three quarters of physicians thought gatekeeping was better than or comparable to traditional care overall"?

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