Specialists as consultants to GPs.Private sector services as an alternative way of organising consultant services in health care

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Abstract
Objective - To assess the effect on referral rate when GPs are given a better opportunity to send their patients to specialists for consultation. Design - Intervention study with a control group. Setting and subjects - A 34-month experiment in the City of Turku. The experimental group consisted of 10 GPs working in municipal health centres with a list system and serving 23000 residents. As a control group, there were four GPs without a list system serving 10800 residents. Outcome measures - GP visits and their referrals to specialists. Results - The number of patient visits was higher among GPs in the experimental group than among those in the control group. During the experiment, the referral rate of GPs in the experimental group increased from 5.7% to 6.8%, but there was no change among the control GPs. Of all referrals to specialists, the share to the private sector increased from 5% to 35%, while at the same time the share to the hospital outpatient clinic decreased. Conclusions - An enhanced possibility to consult private specialists increases the number of referrals, but there are no consequent changes in the relative shares of the consulted specialties.

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