The preferred doctor scheme: a political reading of a French experiment of gate-keeping

Health Policy. 2010 Feb;94(2):129-34. doi: 10.1016/j.healthpol.2009.09.001. Epub 2009 Oct 12.


Objectives: Since 2006 France experiences an innovative version of Gate-keeping which aims at regulating access to outpatient specialist care. We describe the reform's initial objectives, the political pathway which lead to the implementation of a reshaped reform and discuss the first outcomes after 1 year implementation. In the conclusion, we try to catch a glimpse for future steps of the reform.

Methods: In order to observe the implantation and impact on the reform, we used national sickness fund databases and a sample of 7198 individuals from the 2006 French Health, Health Care and Insurance Survey (ESPS), including health, socio-economic and insurance status, questions relating to patient's understanding and compliance with the scheme, self-assessed unmet specialist needs since the reform.

Results and discussion: 2006 results show that 94% chose a preferred doctor, in a vast majority their family doctor. Impact on access to specialist care appears significant for the less well off and those not covered by a complementary insurance. From the specialist's side, new constraints on access to care seem to have been offset by rises in fee schedules.

Conclusion: Notwithstanding disappointing short terms results, the new scheme may however lead up to reinforced managed care reforms.

MeSH terms

  • Data Collection
  • France
  • Gatekeeping / organization & administration*
  • Health Care Reform
  • Humans
  • Physicians*
  • Politics*
  • Referral and Consultation