Gatekeeping and provider choice in OECD healthcare systems

Gatekeeping and provider choice have become central in health policymaking within the last two decades. This article contributes to the debates in two ways: first, it provides an extended review of evidence on the impact of gatekeeping and provider choice on efficiency, costs, quality, equality and patient empowerment; and second, it empirically analyses regulations and identifies common trends in healthcare reforms in OECD countries since 1990. More than half of the countries analysed have established gatekeeping systems, while a smaller number provides free access to secondary care. The study discovers a trend towards strengthening gatekeeping regulations within free access countries. Free choice of provider is the standard in the OECD, where only a small number of countries restrict provider choice. The article identifies a diverging trend of reforms, with some traditionally restrictive countries offering more provider choice and other countries limiting the choice of providers as a result of managed care reforms.