Physicians as gatekeepers: will they contribute to restrict disability benefits?

Abstract

Objective - To study how general practitioners (GPs), specialists, and National Insurance Administration (NIA) medical consultants reacted to the narrowed eligibility criteria for disability benefits in Norway from 1991. Design - Records of first-time applicants for disability benefits from the first quarters of 1990 and 1993 were analysed for proposals from the physicians in relation to the decision. Setting - Two Norwegian counties, Østfold and Møre and Romsdal. Subjects - 668 applicants - half the granted cases, and all the refused ones. Results - The number of applicants fell by 39% from 1990 to 1993 and the refusal frequency increased from 8 to 21%. Nevertheless, GPs recommended refusal to about the same extent as before, 8-9% of all cases, with probably a minor fall from 52 to 42% of the refused ones (p=0.19). Specialists did not recommend more refusals than the GPs. Cases evaluated by the NIA medical consultants increased from 29 to 41%, and their concordance with the patients' GPs seemed to be ~50%. GPs did not give more detailed medical descriptions in 1993 than in 1990, and discussed eligibility criteria but slightly more comprehensively. Conclusion - GPs are willing to act as gatekeepers for social insurance benefits for their patients, also when eligibility criteria become restricted.