Lower referral rates for integrated health centres in The Netherlands.

The strengthening of primary health care is an important issue in health policy in The netherlands. The stimulation of co-operation and cohesion within primary health care and, in particular, the stimulation of integrated health centres is supposed to be an important mean to reduce the expansive growth of expenditures in the so-called second line (mainly medical specialists and hospitals). This article first describes recent trends in co-operation within primary health care and referral rates. For a better understanding of the issue in the context of the Dutch health care system we will also describe some of the rationale of the government policy to strengthen primary health care. In the second part results are presented of a study carried out to test if differences in referral rates among GPs in different practice settings can be explained by structural factors.