One of primary healthcare facility quality indicators is the low non-specialist referral. Non-specialist referral is referral of 144 diseases that should be arranged in primary healthcare facilities. In fact, there are many non-specialist cases referred to secondary health care facilities. This descriptive study using quantitative and qualitative method aimed to determine patterns and causes of non-specialist diseases referred to secondary primary health care in Pekanbaru City. Depiction of non-specialist disease cases was collected from data of the state health insurance scheme in Pekanbaru City on December 2014 - April 2015 period, meanwhile causes of referral were obtained from focus group discussion participated by 40 doctors based on types of primary healthcare facilities. This study showed 20 non-specialist cases oftenly referred including essential hypertension, mild myopia and diabetes mellitus. Causes of non-specialist disease referrals were code error as well as limited facilities, human resource, service management and competence of doctors. Such limitations need to be anticipated in order to minimalize act of referrals.