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Cooperation of general practitioners in referral networks: Impact on health outcomes and costs in chronic care

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  • Cordes, Sophia
  • Stargardt, Tom

Abstract

Effective coordination and cooperation between general practitioners (GPs) and other outpatient physicians are essential for managing chronic conditions. However, evidence on how the structure of outpatient referral networks supports such coordination and cooperation, and how it relates to patient outcomes is limited. This study examined whether GPs’ structural positions within outpatient referral networks were associated with hospitalization, mortality, and health care costs in patients with chronic heart failure. Using administrative claims data from Germany, we applied social network analysis to quantify GP brokerage positions (betweenness), GP embeddedness (PageRank), and GP–cardiologist connectedness (degree). To address potential endogeneity, we used an instrumental-variable approach, combining hurdle models for hospitalization, Cox regression for mortality, and generalized linear models for costs.

Suggested Citation

  • Cordes, Sophia & Stargardt, Tom, 2026. "Cooperation of general practitioners in referral networks: Impact on health outcomes and costs in chronic care," Social Science & Medicine, Elsevier, vol. 403(C).
    • Handle: RePEc:eee:socmed:v:403:y:2026:i:c:s0277953626004946
    DOI: 10.1016/j.socscimed.2026.119418
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    JEL classification:

    • C51 - Mathematical and Quantitative Methods - - Econometric Modeling - - - Model Construction and Estimation
    • D85 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Network Formation

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