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October 16, 1981

Cost of Primary Care Plans

JAMA. 1981;246(16):1769-1770. doi:10.1001/jama.1981.03320160011010

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To the Editor.—  Recently, John P. Geyman, MD, wrote on the topic of future medical practice in this country (1981;245:1140). He stressed the need for change and urged an "overriding concern for the public interest, not the vested interest of any particular group."I found the aforementioned sentiment particularly noteworthy when I saw that the author, a member of a university department of family medicine, was making a case for "primary care" medicine as the approach of the future. This is the system in which the patient (subscriber to a particular health plan) has access only to primary care physicians. This also has been called the "gatekeeper" system. A patient can only see, for example, an ophthalmologist, allergist, orthopedist, dermatologist, or otolaryngologist if the "gatekeeper" physician makes the referral. In most plans only a single visit is permitted without further approval of the "gatekeeper." In many plans, a sum of