Approaches to regulating self-referral in Canada.

Self-referral by physicians is a source of frequent debate.1 In some circumstances, selfreferral can result in better continuity of care, speedier diagnoses, and improved timely access to health care services. From an ethical and legal perspective, however, self-referral is often criticised because it can result in a conflict of interest between a physician’s primary legal and ethical duty to act in the best interest of his or her patient and the financial incentive associated with making the referral. From a public policy perspective, self-referral is also viewed with some suspicion because self-referral practices tend to be correlated with higher use of insured diagnostic procedures, which, in addition to being potentially inappropriate for patients, may be costly for the public health care system.