Patient Views for Self-Referral to Specialists

Background: Except in emergency cases, all patients should be seen first by a primary health care physic ian who decides whether a referral to secondary care is necessary. The present stud y examined the reasons for patient self-referral to specialists. Methods: A random sample of 1036 individuals was selected from people attending public outpatient clin ics and specialist s offi ces in the privat e health sector. Of the sample, 40% were insured by the closed loop referral; 14% by the semi-closed-loop referral; and 46% were open referral. The data were analysed using X2 statistical test. Results: Of the closed-loop referral system patients, 6.8% were self-referred, as were 29 .7% of semi-closed referral system patients and 75.5% of open referral system patients. There was a significant association between insurance type and patient self-referral to specialty care (X2 = 504; P 0.000 I). The main reasons patients gave for by-passing OPs and self-referring to specialists were: the specialist s high degree of sk ill in the specific area of the health problem (54%); waste of time to see the OP for a referral (14 .9%). Conclusion: The findings of this study demonstr ate the high degree of differen ce in the rates of referral by OP and self-referral according to the health care del ivery system.