The Effects of Elimination of Gate-Keeping on Tertiary Care and the Social Insurance System

The aim was to investigate the effects of elimination of gatekeeping on a university hospital and Social Insurance Institute (SII). Electronic records of 2006-2007 were analyzed. The mean outpatient visits was 273.8±69.9 before the gate-keeping elimination, it was 471.8±114.7 after the gate-keeping elimination (p 0.001). The increased rate of visits were in the department of cardiology (95.4%) followed by respiratory medicine (33.3%), orthopedics (22.6%), neurology (16.1%) and gynecology (11.4%). Also the most frequent diagnoses changed in these departments. The most frequent diagnoses before and after elimination were as follows; hypertension in comparison to anxiety disorders after elimination in cardiology, chronic obstructive lung disease compared to myalgia in respiratory medicine, fracture follow up compared to joint pain in orthopaedics, epilepsy compared to dizziness in neu- rology and infertility compared to vaginitis in gynecology. SII has paid 10.67 fold higher dues after elimination for these 7 departments and diagnoses. Consequently; elimination of the gate-keeping can easily be applied to tertiary care and can increase health expenditures.