What role does a gatekeeper play in a managed care system?

In a managed care system, a gatekeeper plays a crucial role in managing patient care and controlling costs. The primary function of a gatekeeper, often a primary care physician, is to filter referrals for specialty care. This means that before a patient can see a specialist or receive certain types of medical services, they must first consult their primary care provider, who assesses the necessity and appropriateness of the referral.

This system is designed to prevent unnecessary or potentially costly procedures and ensure that care is coordinated effectively. By controlling access to specialists, the gatekeeper helps to manage healthcare expenditures and encourages a focus on preventative care, thus reducing overall healthcare costs for both the patient and the insurance provider. This role is essential in maintaining the cost-efficiency and quality of care for patients within a managed care framework.