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October 1989

Differences in Strategies for the Diagnosis and Treatment of Neurologic Disease Among British and American Neurologists

Author Affiliations

From the Research Unit, Royal College of Psysicians of London (England) (Dr Hopkins); the Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick (Dr Menken); School of Medicine and Health Services Research Center, University of North Carolina, Chapel Hill (Dr DeFriese); and Department of Neurology, Boston (Mass) University School of Medicine (Dr Feldman).

Arch Neurol. 1989;46(10):1142-1148. doi:10.1001/archneur.1989.00520460138029

There is, at present, considerable interest in the differences among medical specialties in the way in which certain types of medical care are provided. Much of the impetus for the study of interspecialty comparative health services research arises from the effort to measure the differences between specialist and generalist physicians in the nature, volume, and costs of care for much the same types of clinical conditions. In the United States, the study of interspecialty differences in medical care is important with respect to the national effort to assure adequate access to primary health care services, on the one hand, and the effort partially to reduce health sector costs through formal mechanisms of control that limit patient access to specialist services. A variety of systems of control have been introduced that make access to specialist services possible only with the concurrence of a primary care physician (eg, the so-called gatekeeper