Patient Flows to Hospital — An Economist's Perspective

The workload of acute hospitals in the United Kingdom is largely determined by referrals by general practitioners (GPs), and there have been studies that show great variation in the rate and pattern of referrals by different GPs. The other major route is to attend the accident and emergency department (A&E) without attending the GP. It is argued in this paper that the ‘problem’ of variations in GP must be seen in the general context of patient flows to hospital, since little is known of the relationship between referrals and self‐referrals. If it is the case that self‐referral behaviour depends on the likelihood of being referred by a GP, then differences in GP behaviour will not have a direct effect on hospital workload. Equally, changing their behaviour will not reduce the demand for hospital services. Two other options are worth considering — attempting to change the behaviour of patients by public education, and controlling access to hospital by triage. The paper sets out a research agenda to help resolve some of these issues.