Why manage referrals?

Many healthcare systems such as those in the United Kingdom, the Netherlands, and some health maintenance organisations in the United States use gatekeepers to regulate the flow of referrals from generalists to more specialised colleagues. Interest in managing demand arose in the US during the mid-1990s as health providers tried to curtail costs.7 Despite these origins, an important facet of managing demand is to encourage referrals to services that are both underused and cost effective.8 The accepted definitions recognise that management is equally concerned with creating and coping with demand as well as curtailing inappropriate flows.

Nevertheless, many initiatives seem to have an emphasis on reducing referrals.9 Referral management centres seem to have been largely set up to monitor the flow of referrals from generalists to specialists and often state that their prime aim …