Unbiased Analysis of Today's Healthcare Issues

Information on Referrals II

Written By: Jason Shafrin - Oct• 11•06

If my October 10th post did not satiate your desire for knowledge regarding referrals, today I give you even more information. 

  • Franks, Zwanziger, Mooney and Sorbero examine a large Rochester, NY Independent Practitioner Association (IPA).  The authors find a mean patient referred/patients seen/year of 0.37.  The data show that referral rates remain very stable by physician over time, likely due to physician stable case mix.  Franks et al. conclude that referrals are driven by physician recommendations, not patient demand.
  • Shea, et al. look at data from the 1992-1993 Medicare Current Beneficiary Survey (MCBS).  They find that only 36% of referrals are from primary care physicians to specialists.  Primary care to primary care and specialist to specialist referrals account for 45% of referrals and specialist to primary care referrals make up 4%.  The balance is made up from within-specialty referrals.  As opposed to Franks et al., the authors conclude that patient demand (not supplier recommendations) are the major driver of referrals. 

Franks, Peter; Zwanziger, Jack; Mooney, Cathleen; Sorbero, Melony (1999), “Variations in primary care physician referral rates,” Health Services Research, vol 34(1), pp. 323-329.

Shea, Dennis; Stuart, Bruce; Vasey, Joseph; Nag, Soma (1999),”Medicare physician referral patterns,” Health Services Research, vol 34(1), pp. 331-348.


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  1. D. Shea says:

    Found your blog while watching the Cards and Mets and must have been driven by some invisible hand, since I see one of my own papers referenced in your 10/11 post. In my opinion, I think the results of Franks et al and Shea et al are driven as much by their data as underlying reality. Franks had a data set rich in physician measures and poor in patient measures. The MCBS used in our study is the reverse. It would be nice to get a study that had good measures of both sides.