Will German patients accept their family physician as a gatekeeper?

Abstract

OBJECTIVE: Looking to the experience in the United States with managed care and the possible introduction of gatekeeping in the near future in Germany, we performed a population-based survey to examine preferences for future gatekeeping arrangements. DESIGN: Cross-sectional telephone survey. SETTING: Four health districts in Thuringia (formerly East Germany) and Lower Saxony (formerly West Germany). PARTICIPANTS: Out of a random sample of 644 adults in the 4 districts, 415 persons (64.4%) took part in the survey. MEASUREMENTS AND MAIN RESULTS: Using multiple logistic regression, we analyzed associations between preferences for gatekeeping arrangements and patient satisfaction, insurance status, and sociodemographic characteristics. Seventy-four percent of respondents valued first-contact care, especially older people (odds ratio [OR], 4.3; 95% confidence interval [95% CI], 2.0 to 9.3), people who were very satisfied with the relationship with their family physician (OR, 2.7; 95% CI, 1.6 to 4.8) and members of sickness funds in contrast to privately insured persons (OR, 2.4; 95% CI, 1.2 to 5.2). The family physician's influence in coordinating the use of specialist services was appreciated by 86%, more often by members of sickness funds (OR, 5.9; 95% CI, 2.4 to 14.3), people who were very satisfied with their doctor's professional competence (OR, 3.2; 95% CI, 1.6 to 6.3) and older persons (OR, 2.9; 95% CI, 1.1 to 7.7). CONCLUSIONS: A vast majority of the German population would accept their family physician as entry point and as coordinator of all other health services. Since patient satisfaction, among other reasons, strongly influenced preferences for gatekeeper arrangements, family physicians themselves may be able to promote primary care health services.