Referral for a free specialist doctor consultation: who issues and when?
In most cases, a referral for a specialist doctor consultation covered by the Compulsory Health Insurance Fund is issued by a family doctor or a specialist doctor. The important point is that the doctor must work at a healthcare facility that has an agreement with the National Health Insurance Fund for the particular service for which the referral is being issued.
Family Doctors Treat Many Health Condition
Healthcare most often starts with a family doctor – this is the first doctor we usually turn to when we feel unwell or experience health problems. The family doctor assesses the patient’s condition, listens to the complaints, orders the necessary tests, makes a diagnosis and provides treatment. They can diagnose and treat most common diseases and health conditions, so a specialist consultation is not always necessary.
“The patient experiences symptoms, while the family doctor assesses the overall picture – the medical history, test results, risk factors and general state of health. Based on this, the doctor determines whether a specialist consultation is medically necessary and which specialist could help,” says family doctor Alma Astafjeva, Chairwoman of the Lithuanian Family Doctors’ Trade Union.
A referral is issued only when, after assessing the patient’s condition, the family doctor determines that there are medical indications for a specialist consultation. If the health condition or disease can be diagnosed and treated by the family doctor and their team, there is no need for a specialist’s assistance.
For example, headaches do not necessarily indicate a neurological disorder – they are often related to fluctuations in blood pressure, stress or other factors that can be managed by a family doctor. In cases of back or joint pain, conservative treatment is often provided first, including medication, adjustments to physical activity, physiotherapy or other measures. If such treatment is insufficient or a more detailed examination is required, the family doctor refers the patient to a specialist doctor.
A Specialist Doctor Can Refer a Patient to Another Specialist
In certain cases, a specialist doctor may also issue a referral when, during treatment, it becomes apparent that a consultation with a specialist in another field or a
For example, if, while treating a heart rhythm disorder, a cardiologist suspects that it may be related to a disorder of the hormonal system, the patient may be referred to an endocrinologist. If an orthopaedic traumatologist suspects that joint pain is caused by an inflammatory disease, the patient may be referred to a rheumatologist for a consultation.
In such cases, the patient does not need to contact his/her family doctor solely to obtain a referral – he/she can register directly with the specialist indicated on the referral.
More Opportunities to Issue Referrals for Covered Services
As of 1 July, at all healthcare facilities that have an agreement with the National Health Insurance Fund – both public and private – specialist doctors may issue referrals for services covered by the National Health Insurance Fund during both free-of-charge and paid consultations.
This means that, during a paid consultation, a doctor may issue a referral to an insured person for a subsequent service covered by the National Health Insurance Fund, provided that the referral is issued as part of a consultation for which the healthcare facility has an agreement with the National Health Insurance Fund. In addition, the doctor must determine that, given the patient’s health condition, it is appropriate for them to receive further covered services. The mere fact that a person has paid for a consultation does not, in itself, provide grounds for issuing a referral for covered services.
The doctor records this information on the referral, and the patient may choose a healthcare facility that has an agreement with the National Health Insurance Fund and where he/she wishes to receive the service specified in the referral.
“This procedure is particularly relevant when, following a consultation with one specialist doctor, a patient requires a consultation with another specialist or other covered services. In such cases, the pathway to the required service becomes shorter and simpler,” says Indrė Lyvė, an adviser of the Service Reimbursement Division of the National Health Insurance Fund.
A decision on whether to issue a referral is always made on an individual basis. In some cases, it is issued immediately; in others, it is necessary to wait for test results or assess the effectiveness of treatment. Quite often, a specialist consultation is not necessary because the care required by the patient can be provided by the family doctor and their team. A referral is not a separate service – it is a medical decision made based on the patient’s health condition and treatment needs.
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