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

Objective - To study how general practitioners (GPs), specialists, and Nati onal Insurance Administration (BIA) medical consultants reacted to the narr owed 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 physic ians in relation to the decision. Setting - Two Norwegian counties, Ostfold and More 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 re fusal frequency increased from 8 to 21%. Nevertheless, GPs recommended refu sal 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 c onsultants increased from 29 to 41%, and their concordance with the patient s' GPs seemed to be similar to 50%. GPs did not give more detailed medical descriptions in 1993 than in 1990, and discussed eligibility criteria but s lightly more comprehensively. Conclusion - GPs are willing to act as gatekeepers for social insurance ben efits for their patients, also when eligibility criteria become restricted.