Generalists Or Specialists--Who Does It Better? (Value-Based Health Care)‪.‬

THE U.S. HEALTH CARE SYSTEM IS UNDERGOING A historic transformation. Unbridled increases in the cost of health care during the past two decades, the development of a highly competitive global economy, and a burgeoning federal deficit have forced the major purchasers of heath care, businesses, and the U.S. government to focus on cost containment. (1) Unable to control the cost of care for their employees and beneficiaries, the purchasers of health care are increasingly turning to managed care companies for help. Managed care companies use a variety of strategies to hold down costs, including restricting access to specialists and the services they provide. A method favored by many managed care companies is to require beneficiaries to select a primary care provider, who is almost always a generalist (family practitioner, general internist, or pediatrician), to guide them through the health care system, the so-called gatekeeper model.