Association between general practice referral rates and patients' socioeconomic status and access to specialised health care a population-based nationwide study

Health Policy. 2009 Oct;92(2-3):180-6. doi: 10.1016/j.healthpol.2009.03.011. Epub 2009 Apr 24.


Objectives: To explore the association between patients' socioeconomic status and their referral from general practice to specialised health care.

Methods: Multiple regression analysis was used on cross-sectional data on general practice referral rates for all Danish general practices in year 2006.

Results: Our models explained between 26% and 45% of the variation in general practice referral to specialised care. Adjusting for access to specialised care (local supply of hospitals and practicing specialists) reduced the association between socioeconomic factors and referral rates. The results suggest that persons with high socioeconomic status are referred more to practicing specialist than persons with low socioeconomic status and that the latter are referred more to hospital care than the former.

Conclusions: Our results indicate that the influence of socioeconomic factors may be overstated failing to control for access to specialised care. Still, a socioeconomic gradient was observed in GPs' referral pattern to different sorts of health care after adjusting for access. The association between socioeconomic status and referral pattern can both be rooted in morbidity variation and to the ability of persons with high socioeconomic status to influence general practitioners' (GPs') decision making.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Denmark
  • Female
  • General Practice / statistics & numerical data*
  • Health Services Accessibility / economics*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Medicine
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data*
  • Socioeconomic Factors
  • Young Adult