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

Objective - To assess the effect on referral rate when GPs are given a bett er 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 expe rimental group consisted of 10 GPs working in municipal health centres with a list system and serving 23 000 residents. As a control group, there were four GPs without a hst 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 experime ntal group than among those in the control group. During the experiment, th e referral rate of GPs in the experimental group increased from 57% to 6.8% , but there was no change among the control GPs. Of all referrals to specia lists, the share to the private sector increased from 5% to 35%, while at t he same time the share to the hospital outpatient clinic decreased. Conclusions - An enhanced possibility to consult private specialists increa ses the number of referrals, but there are no consequent changes in the rel ative shares of the consulted specialties.