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August 12, 1988

Physician Referrals in a Competitive Environment

Author Affiliations

Health Plan of Mid America Kansas City, Mo

Health Plan of Mid America Kansas City, Mo

JAMA. 1988;260(6):791. doi:10.1001/jama.1988.03410060061023

To the Editor.—  As a physician who has served as a medical director in several third-party payer organizations, the article in the March 18 issue of JAMA about physician referrals caught my eye. The referrals, as briefly outlined, do not allow one to identify them as appropriate or necessary, but at first blush one would suspect the goal of case management in the prepaid group was probably not being met, if the referral rates were equal.While not wishing to plant the seeds for future referral abuse, I also would like to point out a referral pattern that may be unethical and that seems to be growing in our competitive world, certainly adding to the cost of medical care. The situation usually involves a generalist who finds that his practice has a lot of outgoing referral work. The generalist then insists that the specialist see referred patients in space rented