Article: Variations in primary care physician referral rates.(A Memorial to Alice Hersh)

Referral decisions made by primary care physicians (PCPs) have a significant effect on the cost and quality of care that patients receive. Referrals induce expenditures (Glenn, Lawler, and Hoerl 1987), in part because specialist care is more intense than that provided by PCPs (Greenfield et al. 1992). Excessive referrals may result in unnecessary, possibly harmful interventions (Franks, Clancy, and Nutting 1992). Underreferral may result in adverse outcomes (Roland, Green, and Roberts 1991) or require interventions that are ultimately more expensive. Increasing pressures exist in managed care organizations (MCOs) for primary care physicians to reduce their referral rates, ...

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