In a managed care system, the person who decides what medical services a patient may have access to. Often it is the primary care physician, but it also may be a nonphysician case manager.
A primary care physician, or occasionally another physician, to whom a defined insured population is assigned and who is required either to provide all health care or to authorize care from other specialists, if necessary, for the insured individual.
The person responsible for determining the services to be provided to a patient and coordinating the provision of the appropriate care. The purposes of the gatekeeper’s function are: (1) to improve the quality of care by considering the whole patient, that is, all the patient’s problems and other relevant factors; (2) to ensure that all necessary care is obtained; and (3) to reduce unnecessary care (and cost). When, as is often the case, the gatekeeper is a physician, she or he is a primary care physician and usually must, except in an emergency, give the first level of care to the patient before the patient is permitted to be seen by a secondary care physician. In fact, the gatekeeper must refer the patient for the secondary care. It has been suggested that the term “primary care manager (PCM)” replace the widely-used term “gatekeeper,” but “gatekeeper” is likely to be retained.
Primary care or other health care provider who coordinates the utilization and delivery of medical services.
A primary care provider, usually a family physician, internist, or pediatrician, who provides primary health care services to people enrolled in health insurance plans. A gatekeeper is generally responsible for coordinating a person’s overall health care. In health plans that use a gatekeeper, the doctor, except in time of an emergency, is consulted before using services such as laboratory testing or being referred to a specialist. Gatekeepers are sometimes called care coordinators. There are some who prefer the term “gate openers” so as not to associate the process with denial of treatment, but rather with providing appropriate and timely health care service.
A person who decides whether further medical assistance or care should be sought or allowed.