The gate is open: Primary care physicians as social security gatekeepers

Primary care physicians have two roles: the healer and the gatekeeper. We show that, due to information asymmetries, they cannot be expected to fulfill the latter role. Better gatekeepers will be poorer healers; hence all patients, both truly sick and shirkers, will strictly prefer physicians who give priority to healing. The choice between work and sick leave thus lies, essentially, with the patient. Interviews with Norwegian primary care physicians confirm this: Our interviewees report that shorter sick leaves are granted at request, while longer sick leaves are normally granted if the patient still prefer so after discussions with the physician.