Freedom of choice - always beneficial?

Isabelle Peytremann-Bridevaux and colleagues addressed a question which is very interesting regarding the ongoing discussion among Swiss physicians about managed care [1]. Managed care includes a strong role for the primary care physician; he usually becomes a gate-keeper within the healthcare system. Without his (or her) initiative a referral to a specialist is impossible or at least much more expensive for the patient. Many specialists fear the implementation of such systems, and the initiated referendum against the managed care initiative reflects the divorce regarding this issue among primary care physicians and specialists in Switzerland [2, 3]. But gate ‐ keeper roles also exist without managed care models, as e.g., in the Netherlands or in the National Health Service (NHS) in the United Kingdom. The evidence from various studies and analys