Gatekeeping and provider choice have become central in health policymaking within the
last two decades. This article contributes to the debates in two ways: first, it provides an
extended review of evidence on the impact of gatekeeping and provider choice on efficiency,
costs, quality, equality and patient empowerment; and second, it empirically analyses
regulations and identifies common trends in healthcare reforms in OECD countries since
1990. More than half of the countries analysed have established gatekeeping systems, while
a smaller number provides free access to secondary care. The study discovers a trend
towards strengthening gatekeeping regulations within free access countries. Free choice
of provider is the standard in the OECD, where only a small number of countries restrict
provider choice. The article identifies a diverging trend of reforms, with some traditionally
restrictive countries offering more provider choice and other countries limiting the choice
of providers as a result of managed care reforms.
