Regulating Patients’ Access to Healthcare Services

Although some healthcare systems have introduced gatekeeping that forces patients to choose a general practitioner for a longer period, other systems rely on a free choice of doctors. This paper analyzes how these instruments affect differences in healthcare utilization in European countries. Using data from the first wave of the Survey of Health, Aging and Retirement, the authors investigate how access regulations affect a) the overall level of ambulatory healthcare usage, and b) disparities in utilization among groups with different educational and income levels. The data show that access regulation affects patients’ decisions to see a doctor and reduces the extent of specialist healthcare used. Cost sharing could not be related to inequities among income groups; however, gatekeeping has favorable effects on reducing inequality, and the respective healthcare systems show lower levels of inequality among groups with different levels of education.