In the 1990’s, primary care gatekeeping became a hallmark of managed care and a major model of health care delivery. Proponents claimed that gatekeeping—requiring that primary care providers preauthorize specialty visits— could control costs and improve coordination of care. However, much of this potential has remained unrealized, and managed care organizations are beginning to loosen these restrictions. This Issue Brief adds to the growing literature on the ineffectiveness of gatekeeping in controlling costs in pediatric care. The following study focuses on privately insured children, and analyzes the impact of gatekeeping on their health care expenditures.