The questions addressed in this paper are related to access rules to primary care services and the potential for patient driven competition between GPs and specialists. Most of the literature on the performance of primary care has dealt with reforming payment schemes, little attention being paid...

This paper analyses the potential costs and benefits from patient driven competition between GPs and specialists by comparing gate-keeping with direct access to specialist care. The two access rules are compared under fee-for-service and capitation, on their performance at minimizing both total...