Rising healthcare expenditure and more explicit rationing of healthcare resources is a central feature of healthcare systems globally. In Australia, reform efforts have targeted the high cost areas such as the public hospital system. This has increased the demands on professionals to reduce length of stay and complicated post-hospital referral of people with complex and severe injury. In the area of traumatic brain injury (TBI), pressures on existing rehabilitation resources and a changing healthcare environment, with greater emphasis on efficiency and evidence-based practice, confront professionals' efforts to provide equitable care. In this paper, some of the key issues important in understanding patterns of referral in TBI are presented. It is argued that referral decisions exemplify a negotiation of professional claims and value judgements that not only conceal the uncertainty in decision-making, but also more notably, reflect the lack of attention to equity in the broader politics of care. Case studies are used to illustrate these issues and to discuss the implications for equitable care in the contemporary healthcare environment in Australia. The paper concludes by outlining the challenges and opportunities in applying evidence-based decision-making in TBI and some future directions for attaining more equitable patterns of referral.