Gatekeeping Revisited — Protecting Patients from Overtreatment

Over 90 percent of health maintenance organizations (HMOs) use care physicians as gatekeepers, whose role is to authorize access to, emergency, and hospital care and to diagnostic tests. Gatekeeping come to imply the medically limited and bureaucratic function of opening closing the gate to high-cost medical services. This simplistic view of is controversial, both because of its menial connotation and of the implication that the physician is the agent of the third-party, not the patient. The purpose of this paper is to reclaim the gatekeeper and to emphasize a more empowering role of patient advocacy, that of patients from the detrimental effects of unnecessary medical.