title: Specialists as consultants to GPs. Private sector services as an alternative way of organising consultant services in health care.
abstract: OBJECTIVE
  To assess the effect on referral rate when GPs are given a better opportunity to send their patients to specialists for consultation.
  
  
  METHODS
  Intervention study with a control group.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Social Insurance Institution, Research and Development Centre, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Linnala
authors.forename: A
authors.initials: A
authors.lastname: Aromaa
authors.forename: K
authors.initials: K
authors.lastname: Mattila
mesh_terms: D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration*; D005387:Finland; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D008511:Medicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D011331:Private Practice / Q000458:organization & administration / Q000706:statistics & numerical data*; D017149:Private Sector; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D013038:Specialization