Score contribution per author:
α: calibrated so average coauthorship-adjusted count equals average raw count
We develop a principal‐agent model in which the health authority acts as a principal for both a patient and a general practitioner (GP). The goal of the paper is to weigh the merits of gatekeeping versus non‐gatekeeping approaches to health care when patient self‐health information and patient pressure on GPs to provide referrals for specialized care are considered. We find that, when GPs incentives matter, a non‐gatekeeping system is preferable only when (i) patient pressure to refer is sufficiently high and (ii) the quality of the patient's self‐health information is neither highly inaccurate (in which case the patient's self‐referral will be very inefficient) nor highly accurate (in which case the GP's agency problem will be very costly). Copyright © 2009 John Wiley & Sons, Ltd.