Referral Relationships between General Practitioners and Specialists: Evidence from an unregulated fee market

Chenhao Liang (), Susan J. Méndez (), Ou Yang () and Yuting Zhang ()
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Chenhao Liang: Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia, https://findanexpert.unimelb.edu.au/profile/1006717-ryan-liang
Susan J. Méndez: Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia, https://findanexpert.unimelb.edu.au/profile/670060-susan-mendez
Ou Yang: Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia, https://findanexpert.unimelb.edu.au/profile/698324-ou-yang
Yuting Zhang: Melbourne Institute of Applied Economic an Social Research, The University of Melbourne, Australia, https://findanexpert.unimelb.edu.au/profile/782676-yuting-zhang

Melbourne Institute Working Paper Series from Melbourne Institute of Applied Economic and Social Research, The University of Melbourne

Abstract: In referral-based systems, general practitioners (GPs) act as gatekeepers to specialist care and usually choose which specialist a patient sees. We examine whether GP–specialist referral relationships are associated with specialist fees, out-of-pocket costs, waiting times and bulk billing (zero patient payment) in Australia, where specialists set their own fees. Using linked whole-of-population administrative data on 6.3 million initial specialist consultations in orthopaedic surgery, dermatology and cardiology between July 2021 and June 2025, we estimate models with GP, specialist and patient-area fixed effects. We measure relationships by their length, the number of consecutive years a GP has referred to the same specialist, and by the concentration of a GP’s referrals, using the Herfindahl–Hirschman Index. In all three specialties, each additional year of collaboration is associated with 0.3–0.8\% higher fees, 3.9–4.5\% higher out-of-pocket costs, 1.9–4.7 days longer waits and a lower probability of bulk billing. Most of the waiting-time difference arises when a pair becomes established. Associations with referral concentration are smaller and largely attenuate once relationship length is accounted for. Providing GPs with information on fees, out-of-pocket costs and waiting times at the point of referral, and prompting periodic review of established referral pathways, could improve affordability and access while preserving continuity of care.

Keywords: Referral relationships; referral concentration; specialists; general practitioners; physician fees; out-of-pocket costs; waiting times; Australia (search for similar items in EconPapers)
JEL-codes: I11 I18 (search for similar items in EconPapers)
Pages: 36pp
Date: 2026-10
New Economics Papers: this item is included in nep-hea
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