Project Description

Author: Samantha Prime1, Christie Gardiner2, Dr Rebecca Haddock3

  1. PhD Candidate | Health Policy, Systems & Services, Queensland University of Technology
  2. Associate Lecturer of Law, University of Newcastle
  3. Director of the Deeble Institute for Health Policy Research

The specialist referral system is a key operational component of the Australian health system, yet despite this, there has been limited scrutiny of the efficacy of the referral framework to support the changing health needs of Australians. A recent report by clinician and PhD candidate Samantha Prime, Associate Lecturer of Law Christie Gardiner and Director of the Deeble Institute for Health Policy Research, Dr Rebecca Haddock, highlights the many shortcomings in the current referral system and proposes key recommendations for reform.

The specialist referral rules were developed in the 70s when acute illness was more common however the increasing prevalence of long-term chronic and complex illnesses requiring long-term specialist care means that the current framework promotes inefficiency through administratively driven medical consultations. The statutory limitations that apply to a referrals ‘period of validity’ are often too short: lasting for only three months if issued by a specialist, and commonly lasting 12 months when issued by a GP. Referral expiration necessitates GP consultations take place in order for patients to obtain a repeat referral. The need for multiple repeat referrals for patients with long-term chronic illnesses can be a financial and logistical burden, causing some to delay treatment.

The principle arguments by clinicians who advocate maintaining the status quo centre around the value of opportunistic patient care and the role of a referral as an essential tool facilitating communication between GPs, patients and specialists. Neither of these arguments are considered adequate justification to prevent reform suggest Prime, Gardiner and Haddock.

Fixing the issues with the referral system requires a better understanding of patients’ long-term health needs and the health and economic consequences of the medical referral framework. ‘Bringing the referral rules in line with contemporary health needs and service structures will require a well-co-ordinated, effective and efficient referral system that facilitates the evidence based and linear transfer of care from one clinician to another within a highly interoperable and collaborative healthcare system’ says Prime, Gardiner and Haddock. Overall, there is strong consumer and clinician support for a more efficient referral system and with further research, evidence-informed policies could guide high-value, cost-effective care.

The full Issues Brief published by the Deeble Institute for Health Policy Research, the research arm of the Australian Healthcare & Hospitals Association can be found at:

https://ahha.asn.au/publication/health-policy-issue-briefs/deeble-brief-no-38-optimising-healthcare-through-specialist

An accompanying news article published in The Conversation can also be found at:

https://theconversation.com/specialist-referral-rules-havent-changed-much-since-the-70s-but-australias-health-needs-sure-have-144506