Diagnostic delays and referral management schemes: how ‘integrated’ primary care might damage your health

For many years I was a disciple of the Starfield hypothesis—thathealthcaresystemswithastronger orientationtohealthpromotion,diseaseprevention,and the provision of accessible, universal and integrated primarycare-basedservicesledbygeneralistphysicianswillachievebetterhealthoutcomesandatlower cost [1]. Moreover, I have been persuaded by the chronic-care advocates that a seismic shift is occurringintheburdenofcarethatnowrequiresasystemic moveawayfromepisodiccareundertakeninspecialist hospital institutions to long-term and integrated caremanagementandcoordinationundertakeninthe community[2].