Barriers to self-referral
Participants described self-referral was restricted by various conditions, especially external factors. The most mentioned were distance to referral hospital, economic condition and medical reimbursement. Those unsurmountable factors usually directly leaded to not referral.
“Self-referral can’t be achieved easily for me, because My families had to suspend normal life and ask for leave work. Besides, it was predicted that the medical bills incurred was higher along with lower reimbursement radio. In general, it would take extra medical expenditure and time”. (P19)
Another barrier was a lack of general knowledge of CKD, including symptoms, the severity of illness and such on. Eight patients regretted no earlier self-referral.
“If give me another chance, I would go to the top hospitals earlier (cry…). I really didn’t know it was going to happen, so did people around me.” (P12)
Two nephrologists expressed another piece of insight about barriers they felt to self-referral during clinic consultation. Four nephrologists expressed their expectation of referral timing and renal disease referral system, reflecting systematic barriers.
“Most self-referral patients are at advanced stage, at which phase physicians can’t take more measures to delay disease progression reversibly. However, self-referral patients seem too resist to accept the bad news. If patients can turn to higher authority hospitals earlier for detecting causes, we may be able to slow disease progression”.(N2)