Physicians often refer patients to institutions rather than to other physicians, a situation that can pose some difficult problems for both the patient and the physician. Most major specialty institutions have specific eligibility criteria and various funding requirements. A children’s hospital may not accept patients who are more than 18 years old but make exceptions for patients who have had surgical repairs of congenital defects in that hospital. A cancer center may not accept patients who do not have private health insurance unless the patient is willing to participate in a research protocol that has outside funding. A physician who wishes to refer a patient to such an institution must make sure that the patient is eligible for care and that the institution is willing to accept him or her. The best way to do this is to call someone in charge of admissions at the institution and follow up the conversation with a letter. If the patient is not eligible for that institution, care can be sought elsewhere quickly and without the inconvenience of being turned away.

Eligibility may be based on the patient’s financial status or residence. Public charity hospitals normally serve residents of a specific area who have incomes below a certain level. These hospitals do not provide free care to everyone. A patient who has no medical insurance may be considered indigent by a private hospital but not be eligible for free services at the county hospital. Before referring a patient to a charity hospital, the physician should check to make sure that the patient will be accepted, as he or she would with any other institutional referral. The referring physician also must be aware of federal antidumping regulations that carry a fine of up to $50,000 against the physician personally for improper transfers to charity hospitals. The fine is beyond any malpractice claim that might be paid by insurance.