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Journal Article


Comparison of Specialty Referral Rates in the United Kingdom and the United States: Retrospective Cohort Analysis

The Issue

Physicians in the United States are known to make greater use of specialty procedures that their counterparts in the United Kingdom. For this study, Commonwealth Fund–supported researchers compared the two countries' rates of referral to specialists—the step before patients undergo specialized procedures.

What the Study Found

The researchers examined referral rates among 384,693 U.S. patients in managed care settings, in which referral processes are similar to those in the U.K., to 757,680 U.K. patients in the general practice research database. They found:

  • In the U.S., across the five health plans studied, 30.0 percent to 36.8 percent of patients annually were referred for specialty care.
  • In the U.K., just 13.9 percent of U.K. patients were referred for specialty care.
  • Independent of disease burden, U.S. patients were referred more commonly than were U.K. patients.


Researchers conclude that the supply of specialists in the U.S.—twofold more than in the U.K.—likely accounts for its much higher referral rate. Other contributing factors may include U.K. physicians' less intensive practice style, the tendency for U.S. patients (even those in HMOs) to self-refer, and a broader scope of practice among U.K. physicians. Referral guidelines have been proposed as a way to reduce pressure on outpatient services in the U.K., but based on these results the authors think they are unlikely to reduce demand for specialty care.

Publication Details



P. Crampton, P. Davis, R. Lay-Yee et al., "Comparison of Specialty Referral Rates in the United Kingdom and the United States: Retrospective Cohort Analysis," BMJ, Aug. 17, 2002 325(7360):370–71.