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Richard Lord,

In developing countries, referral hospitals have long been thought to consume an excessive share of health budgets while making limited contributions to improved health and welfare. A restructuring of referral hospital services is called for to improve appropriate referral and utilization, especially by remote and rural populations; to transform the inappropriate use of referral hospitals as primary health care providers; to improve efficiency; and to provide much better outreach and support to lower levels of care.

The primary function of multispecialty secondary and tertiary referral hospitals is to provide complex clinical care to patients transferred from lower levels, although the exact range of services can vary substantially, even between tertiary hospitals within the same country. Referral hospitals also provide population–level health benefits through direct involvement in public health interventions. Aside from direct patient care, referral hospitals play a role in quality improvement through training personnel and setting standards of treatment; providing managerial and administrative support to other elements of the health system; conducting country–relevant health research; and introducing new technologies.

At the same time, it is indisputable that referral hospitals command a large share of health sector resources. Policy makers concerned that referral hospitals might be diverting resources away from lower levels of care should consider restructuring, not demolishing, these services. This would involve improving appropriate referral and utilization, especially by remote and rural populations, ensuring that referral hospitals are not being used as primary care providers. In this way, referral hospitals in developing countries can contribute not only to quality patient care, but also to the stability of the entire health care system.