{"id":"https://openalex.org/W2415659337","doi":null,"title":"Gatekeeper effects on patterns of physician use.","display_name":"Gatekeeper effects on patterns of physician use.","publication_year":1991,"publication_date":"1991-02-01","ids":{"openalex":"https://openalex.org/W2415659337","mag":"2415659337","pmid":"https://pubmed.ncbi.nlm.nih.gov/1990045"},"language":"en","primary_location":{"id":"pmid:1990045","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/1990045","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of family practice","raw_type":"Comparative Study"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5111725230","display_name":"Robert E. Hurley","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I130769515","display_name":"Pennsylvania State University","ror":"https://ror.org/04p491231","country_code":"US","type":"education","lineage":["https://openalex.org/I130769515"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"R E Hurley","raw_affiliation_strings":["Department of Health Policy and Administration, Pennsylvania State University, University Park","Department of Health Policy & Administration, Pennsylvania State University, University Park"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Policy and Administration, Pennsylvania State University, University Park","institution_ids":["https://openalex.org/I130769515"]},{"raw_affiliation_string":"Department of Health Policy & Administration, Pennsylvania State University, University Park","institution_ids":["https://openalex.org/I130769515"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5109517971","display_name":"Deborah A. Freund","orcid":"https://orcid.org/0009-0005-6834-2896","observed_orcids":["https://orcid.org/0009-0005-6834-2896"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"D A Freund","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5114254044","display_name":"Barbara J. Gage","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"B J Gage","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":2.9124,"has_fulltext":false,"cited_by_count":64,"citation_normalized_percentile":{"value":0.90434783,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":88,"max":95},"biblio":{"volume":"32","issue":"2","first_page":"167","last_page":"74"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":0.4528999924659729,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":0.4528999924659729,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.33399999141693115,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12918","display_name":"Healthcare Systems and Technology","score":0.20739999413490295,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/medicaid-beneficiaries","display_name":"Medicaid beneficiaries","score":0.8799999952316284},{"id":"https://openalex.org/keywords/primary-care-consultations","display_name":"primary care visits","score":0.7760000228881836},{"id":"https://openalex.org/keywords/fee-for-service","display_name":"fee-for-service","score":0.9200000166893005},{"id":"https://openalex.org/keywords/health-care-access","display_name":"health care access","score":0.6779999732971191},{"id":"https://openalex.org/keywords/demonstration-programs","display_name":"demonstration programs","score":0.5690000057220459},{"id":"https://openalex.org/keywords/health-care-utilization","display_name":"health care utilization","score":0.5979999899864197}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9105216264724731},{"id":"https://openalex.org/C73380752","wikidata":"https://www.wikidata.org/wiki/Q609087","display_name":"Gatekeeping","level":2,"score":0.8288605213165283},{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.7466484308242798},{"id":"https://openalex.org/C2984752397","wikidata":"https://www.wikidata.org/wiki/Q3259956","display_name":"Primary care","level":2,"score":0.6845645308494568},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.6420878171920776},{"id":"https://openalex.org/C2781158071","wikidata":"https://www.wikidata.org/wiki/Q55379489","display_name":"Primary care physician","level":3,"score":0.5140348672866821},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.33340147137641907},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.181949645280838},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.0},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.0},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002140","descriptor_name":"California","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002648","descriptor_name":"Child","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008484","descriptor_name":"Medicaid","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true},{"descriptor_ui":"D008511","descriptor_name":"Medicine","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D009515","descriptor_name":"New Jersey","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010820","descriptor_name":"Physicians","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D011320","descriptor_name":"Primary Health Care","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D012017","descriptor_name":"Referral and Consultation","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D013038","descriptor_name":"Specialization","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D015397","descriptor_name":"Program Evaluation","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"pmid:1990045","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/1990045","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of family practice","raw_type":"Comparative Study"},{"id":"mag:2415659337","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/1990045","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":null,"is_accepted":false,"is_published":false,"raw_source_name":"PubMed","raw_type":null}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.8371999859809875,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":7,"referenced_works":["https://openalex.org/W324661568","https://openalex.org/W1973314497","https://openalex.org/W1980274650","https://openalex.org/W1984635934","https://openalex.org/W2043780177","https://openalex.org/W2058179804","https://openalex.org/W2167962526"],"related_works":["https://openalex.org/W2417082804","https://openalex.org/W1988314622","https://openalex.org/W2405699258","https://openalex.org/W2078612531","https://openalex.org/W2051709625","https://openalex.org/W2415763604","https://openalex.org/W2108269432","https://openalex.org/W119426135","https://openalex.org/W1519265897","https://openalex.org/W2413317887"],"abstract_inverted_index":{"The":[0,21],"impact":[1],"of":[2,9,101,116,124],"primary":[3,65],"care":[4,45,66,86],"gatekeeping":[5],"on":[6,57,64],"selected":[7],"patterns":[8,100],"physician":[10],"use":[11,102],"was":[12,72],"examined":[13],"among":[14],"Medicaid":[15],"beneficiaries":[16,25,40,84],"in":[17,41,75,99],"two":[18],"demonstration":[19],"programs.":[20,78],"evidence":[22],"indicates":[23],"that":[24,82],"enrolled":[26,83],"with":[27,38],"gatekeepers":[28,54],"were":[29,55],"significantly":[30],"less":[31],"likely":[32],"to":[33,48,70,94,106,109],"see":[34],"specialists":[35,71],"when":[36,53],"compared":[37],"unenrolled":[39],"comparison":[42],"groups.":[43],"Primary":[44],"visits":[46],"increased":[47],"offset":[49],"these":[50,97],"reductions":[51],"only":[52],"paid":[56],"a":[58,110],"fee-for-service":[59],"basis.":[60],"Increased":[61],"overall":[62],"reliance":[63],"physicians":[67],"as":[68],"opposed":[69],"also":[73,80],"observed":[74],"the":[76,104,118],"gatekeeper":[77],"Findings":[79],"indicate":[81],"received":[85],"from":[87],"fewer":[88],"sources":[89],"than":[90],"they":[91],"had":[92],"prior":[93],"enrollment.":[95],"Although":[96],"changes":[98,126],"have":[103],"potential":[105],"assure":[107],"access":[108],"more":[111],"stable":[112],"and":[113,120],"structured":[114],"system":[115],"care,":[117],"clinical":[119],"long-term":[121],"economic":[122],"consequences":[123],"such":[125],"remain":[127],"unknown.":[128]},"counts_by_year":[{"year":2019,"cited_by_count":1},{"year":2017,"cited_by_count":1},{"year":2016,"cited_by_count":1},{"year":2015,"cited_by_count":1},{"year":2014,"cited_by_count":2}],"updated_date":"2026-11-03T10:50:19.383937","created_date":"2016-06-24T00:00:00"}