Question

In your own words please answer the following question in 250 word count if using internet please cit all reference and if use in answering the following question please cite all quotes.

In an HMO, the primary care physician acts as the "gatekeeper" to all higher levels of care that the patient may need. In theory, this means that the physician decides what is best for the patient and coordinates his or her care, while at the same times working to control costs and trying to ensure the delivery of care in the most efficient manner possible.

Thinking about this from both a provider's and a payer's perspectives, answer the following questions:

What are the advantages and disadvantages of using the gatekeeper system in terms of progressing through the levels of care? Provide an example of each perspective.

What are at least 2 advantages and 2 disadvantages for each group? Provide a rationale for your choices.

Answer 1

Advantages of gatekeeper in level of care providing ;

Providing the all level of care to the needed patients

Easy reach to the treatment regimen

First aid for the patients health problems

Easy getting of referrals and insurance

Cost effective and time consuming

Disadvantages are;

Time consuming

Poor availability of gatekeeper

Not willing in that

Unsatisfied from their treatment ect.....

Advantages for provider ;

Health care providers having an network between one health care institutions to another it will maintain a healthy relationship between us for providing the quality of care to patients

They gaining their own knowledge about the emergency management , referrals, hospitalization and also they having or getting an quality managemnt and good fame

Disadvantages for provider

Time consuming

Difficult in FOCUSING the same patient in long term

Advantages for payers ;

Easy availability of all level of care at one site

Cost effective

Receive quality care

Disadvantages payers are ;

Poor performance of gatekeeper

Poor guidance to patients

Lack of concentration on same patient for long period.