INTRODUCTION: Formal referrals to medical specialists have not been required in Iceland since 1984. In 2006, however, referrals were required for patients to receive reimbursement for cardiologists fees. We studied patients' experiences and opinions on the referral process and explored the potential for quality improvement related to the increase in written communication between referring GPs and cardiologists. MATERIAL AND METHODS: Based on the electronic medical record system, referrals from GPs at Efstaleiti Health Care Center in ReykjavÃ?Âk to cardiologists between 1 June 2006 and 1 April 2007 were analyzed. A total of 344 patients were referred in this period. 245 agreed to participate in a questionnaire study about their opinions on the referral system and 209 (85%) completed the questionnaire. Relevant data on previous contacts with the health care center and received consultants reports from the years 2005-7 were extracted from the record system. RESULTS: Participating patients had a mean age of 72 years, male/female ratio 1:1. Ninety percent (95% C.I. 86-94) regarded the new referral system as more expensive and troublesome, but 89% (95% C.I. 85-94) wanted their cardiologist to send a formal report to the referring GP. The number of reports from cardiologists to the health centre's GPs increased from 43 in 2005 to 326 in 2007. CONCLUSION: Implementation of a referral system led to some dissatisfaction among the patients. On the other hand, it led to a major increase in the information exchange between GPs and cardiologists, in clear accordance with patients' wishes. It would be of interest to study the impact of the increased information flow influenced on the health care delivered.