IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v118y2014i1p48-55.html
   My bibliography  Save this article

The primary–secondary care interface: Does provision of more services in primary care reduce referrals to medical specialists?

Author

Listed:
  • van Dijk, Christel E.
  • Korevaar, Joke C.
  • Koopmans, Berber
  • de Jong, Judith D.
  • de Bakker, Dinny H.

Abstract

Great variation in referral rates between primary care physicians has been the main reason to influence physician's referral behaviour, by for example, stimulating extra services. This study investigated the extent to which the number of therapeutic and diagnostic services performed by primary care physicians influenced referrals. Data was derived from electronic medical records of 70 general practices for the period 2006 until 2010. For the total patient population (N=651,089 patient years) and specific patients groups for whom specific services were performed mostly (28 groups; 10 services), logistic multilevel regression analyses were conducted to determine associations between the number of services performed in a practice and referrals to medical specialists. The total number of services performed in a practice was not associated with the referral rate (OR: 1.00). Only for two specific services was a significant association found: a lower referral rate for minor surgery for patient with sebaceous cysts (OR: 0.98) and a higher rate for Doppler diagnostic tests for patients with other peripheral arterial diseases (OR: 1.04). As the number of services in general practice was rarely associated with referrals, other measures might be more effective in changing referral behaviour. Another explanation for our results could be that certain preconditions have not been met.

Suggested Citation

  • van Dijk, Christel E. & Korevaar, Joke C. & Koopmans, Berber & de Jong, Judith D. & de Bakker, Dinny H., 2014. "The primary–secondary care interface: Does provision of more services in primary care reduce referrals to medical specialists?," Health Policy, Elsevier, vol. 118(1), pages 48-55.
    • Handle: RePEc:eee:hepoli:v:118:y:2014:i:1:p:48-55
    DOI: 10.1016/j.healthpol.2014.04.001
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851014001006
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2014.04.001?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Groenewegen, Peter P., 1991. "Substitution of primary care and specialist care: A regional analysis in Denmark," Social Science & Medicine, Elsevier, vol. 33(4), pages 471-476, January.
    2. Bachman, Keith H. & K. Freeborn, Donald, 1999. "HMO physicians' use of referrals," Social Science & Medicine, Elsevier, vol. 48(4), pages 547-557, February.
    3. Starfield, Barbara & Shi, Leiyu, 2002. "Policy relevant determinants of health: an international perspective," Health Policy, Elsevier, vol. 60(3), pages 201-218, June.
    4. Wijkel, Dirk, 1986. "Lower referral rates for integrated health centres in The Netherlands," Health Policy, Elsevier, vol. 6(2), pages 185-198.
    5. Christopher B. Forrest & Paul A. Nutting & Sarah von Schrader & Charles Rohde & Barbara Starfield, 2006. "Primary Care Physician Specialty Referral Decision Making: Patient, Physician, and Health Care System Determinants," Medical Decision Making, , vol. 26(1), pages 76-85, January.
    6. Atella, Vincenzo & Deb, Partha, 2008. "Are primary care physicians, public and private sector specialists substitutes or complements? Evidence from a simultaneous equations model for count data," Journal of Health Economics, Elsevier, vol. 27(3), pages 770-785, May.
    7. Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Michele Cecchini & Peter Smith, 2018. "Assessing the dose-response relationship between number of office-based visits and hospitalizations for patients with type II diabetes using generalized propensity score matching," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-11, December.
    2. Silvia Fedeli & Leone Leonida & Michele Santoni, 2018. "Bureaucratic institutional design: the case of the Italian NHS," Public Choice, Springer, vol. 177(3), pages 265-285, December.
    3. Yiu-Shing Lau & Gintare Malisauskaite & Nadia Brookes & Shereen Hussein & Matt Sutton, 2021. "Complements or substitutes? Associations between volumes of care provided in the community and hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(8), pages 1167-1181, November.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ryan Tandjung & Seraina Morell & Andreas Hanhart & Andreas Haefeli & Fabio Valeri & Thomas Rosemann & Oliver Senn, 2017. "Referral determinants in Swiss primary care with a special focus on managed care," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-10, November.
    2. Kushida, Shuya & Kawashima, Michie & Abe, Tetsuya, 2021. "Recommending no further treatment: Gatekeeping work of generalists at a Japanese university hospital," Social Science & Medicine, Elsevier, vol. 290(C).
    3. Andrea Gabrio & Catrin Plumpton & Sube Banerjee & Baptiste Leurent, 2022. "Linear mixed models to handle missing at random data in trial‐based economic evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1276-1287, June.
    4. Godager, Geir & Iversen, Tor & Ma, Ching-to Albert, 2015. "Competition, gatekeeping, and health care access," Journal of Health Economics, Elsevier, vol. 39(C), pages 159-170.
    5. Klaus, Püschel & à lvaro, Téllez & Joaquín, Montero & Astrid, Brunner & Blanca, Peñaloza & María Paulina, Rojas & Fernando, Poblete & Tomás, Pantoja, 2013. "Hacia un nuevo modelo de atención primaria en salud: evaluación del proyecto de salud familiar Ancora U.C," Estudios Públicos, Centro de Estudios Públicos, vol. 0(130), pages 23-52.
    6. Martin Gaechter & Peter Schwazer & Engelbert Theurl, 2013. "Entry into the Physicians’ Market: Empirical Evidence from the Outpatient Sector in Austria," DANUBE: Law and Economics Review, European Association Comenius - EACO, issue 4, pages 245-260, December.
    7. Daniele Fabbri & Chiara Monfardini, 2016. "Opt Out or Top Up? Voluntary Health Care Insurance and the Public vs. Private Substitution," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 78(1), pages 75-93, February.
    8. Adolf Kwadzo Dzampe & Shingo Takahashi, 2024. "Financial incentives and health provider behaviour: Evidence from a capitation policy in Ghana," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), pages 333-344, February.
    9. Laudicella, Mauro & Olsen, Kim Rose & Street, Andrew, 2010. "Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data," Social Science & Medicine, Elsevier, vol. 71(10), pages 1872-1881, November.
    10. Dolton, Peter & Pathania, Vikram, 2016. "Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening," Journal of Health Economics, Elsevier, vol. 49(C), pages 193-208.
    11. Zenelabden, Nouran & Dikgang, Johane, 2021. "Satisfaction with water services delivery in South Africa: the effects of social comparison," EfD Discussion Paper 21-7, Environment for Development, University of Gothenburg.
    12. Kollerup, Anna & Wadmann, Sarah & Bek, Toke & Kjellberg, Jakob, 2022. "National clinical guidelines and treatment centralization do not guarantee consistency in healthcare delivery. A mixed-methods study of wet age-related macular degeneration treatment in Denmark," Health Policy, Elsevier, vol. 126(12), pages 1291-1302.
    13. Mousquès, Julien & Renaud, Thomas & Scemama, Olivier, 2010. "Is the "practice style" hypothesis relevant for general practitioners? An analysis of antibiotics prescription for acute rhinopharyngitis," Social Science & Medicine, Elsevier, vol. 70(8), pages 1176-1184, April.
    14. Propper, Carol & Rigg, John A. & Burgess, Simon, 2005. "Health supplier quality and the distribution of child health," LSE Research Online Documents on Economics 6252, London School of Economics and Political Science, LSE Library.
    15. M. Lippi Bruni & L. Nobilio & C. Ugolini, 2007. "Economic Incentives in General Practice: the Impact of Pay for Participation Programs on Diabetes Care," Working Papers 607, Dipartimento Scienze Economiche, Universita' di Bologna.
    16. Frank Eijkenaar & René C. J. A. van Vliet, 2014. "Performance Profiling in Primary Care," Medical Decision Making, , vol. 34(2), pages 192-205, February.
    17. Massimo Baldini & Gilberto Turati, 2012. "Perceived quality of public services, liquidity constraints, and the demand of private specialist care," Empirical Economics, Springer, vol. 42(2), pages 487-511, April.
    18. Michela Ponzo & Vincenzo Scoppa, 2016. "Cost-Sharing and Use of Health Services in Italy: Evidence from a Fuzzy Regression Discontinuity Design," CSEF Working Papers 440, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    19. Bisceglia, Michele & Padilla, Jorge & Piccolo, Salvatore & Sääskilahti, Pekka, 2023. "On the bright side of market concentration in a mixed-oligopoly healthcare industry," Journal of Health Economics, Elsevier, vol. 90(C).
    20. Grytten, Jostein & Carlsen, Fredrik & Skau, Irene, 2009. "Services production and patient satisfaction in primary care," Health Policy, Elsevier, vol. 89(3), pages 312-321, March.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:118:y:2014:i:1:p:48-55. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.