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The preferred doctor scheme: A political reading of a French experiment of Gate-keeping

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DT22PrefDocSchemePolitFrenchExpGatekeeping.pdf (315.6Kb)
Date
2010
Dewey
Economie sociale
Sujet
Managed Care; health care services utilization; unmet needs; Health care reform; Gate-keeping; Evaluation studies
JEL code
I18
Journal issue
Health Policy
Volume
94
Number
2
Publication date
2010
Article pages
129-134
Publisher
Elsevier
DOI
http://dx.doi.org/10.1016/j.healthpol.2009.09.001
URI
https://basepub.dauphine.fr/handle/123456789/12227
Collections
  • LEDa : Publications
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Author
Dourgnon, Paul
Naiditch, Michel
Type
Article accepté pour publication ou publié
Abstract (EN)
Objectives Since 2006 France experiences an innovative version of Gate-keeping which aims at regulating access to outpatient specialist care. We describe the reform's initial objectives, the political pathway which lead to the implementation of a reshaped reform and discuss the first outcomes after 1 year implementation. In the conclusion, we try to catch a glimpse for future steps of the reform. Methods In order to observe the implantation and impact on the reform, we used national sickness fund databases and a sample of 7198 individuals from the 2006 French Health, Health Care and Insurance Survey (ESPS), including health, socio-economic and insurance status, questions relating to patient's understanding and compliance with the scheme, self-assessed unmet specialist needs since the reform. Results and discussion 2006 results show that 94% chose a preferred doctor, in a vast majority their family doctor. Impact on access to specialist care appears significant for the less well off and those not covered by a complementary insurance. From the specialist's side, new constraints on access to care seem to have been offset by rises in fee schedules. Conclusion Notwithstanding disappointing short terms results, the new scheme may however lead up to reinforced managed care reforms.

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