The decision was made to re-audit the legal requirement for and availability of referral guidelines in those countries previously reporting that referral guidelines were not available.
A greater availability of referral health services in the locality has no significant effect on decision to seek care, while greater availability of staff and equipment increases the probability of seeking care when ill.
To update the situation, those countries previously reporting no guideline availability were re-audited with surveys sent out to national professional societies and competent authorities enquiring as to the awareness of availability of national legislation and to the availability of referral guidelines, including work in progress.
A greater availability of referral health services in the locality has no significant effect on the decision to seek care, while the availability of staff and equipment in all HFs, although small, has a positive and causal effect on the decision to seek care, but only among those individuals who can reach a HF within one hour.
Codes on equity included perceptions related to the quality of the service, the access to and coverage of APE services and the availability of referral points.
Practitioners appear less likely to provide some services where the availability of referral services (e.g. for dental and mental health care [ 16]) is limited.
Moreover, on enquiring about the availability of referral slips/forms at the PHC, a few of the respondents at PHC reported the use of plain paper for referral as a substitute for a referral form, due to its unavailability.
Examples of facilitating controls as revealed by the GPs included increased level of risk to the patient, provision of computer-based templates, motivated and educated patients, good clinician skills and knowledge, reasonable practice capacity in terms of personnel and time, and low cost and good availability of referral sources.
Hazard rates are strongly influenced by selection effects operating in the population (e.g. higher availability of referral centers in a given locality), and individuals surviving up to a certain time will on average be less frail than the original population, therefore unobserved individual heterogeneity (or frailty) was also taken into account [ 23].
