In response to escalating costs of healthcare at Kenya Ports Authority (KPA) Medical Services Department, this research investigates the underlying causes that if addressed, will lead to greater cost efficiency. A preliminary examination of archival data and budgetary allocations revealed that referral rates at KPA are disturbingly high and are the main factor accounting for the highest expenditure rates. Over the 10-year period that records are available, the percentage costs of the four major cost drivers are referrals, 48%, medicines 24%, salaries 14.4% and allowances 13.6%. Armed with these facts, the mixed methods study used archived patient data and survey questionnaires with clinicians at KPA Bandari Clinic to unearth the principal reasons for high referral rates. The study premised that inadequate equipment, lack of in-house specialists, increased health-seeking behaviour, disease patterns and burdens, among others, would explain the high referral rates. Findings confirmed these assumptions, revealing that clinicians’, patients’, and KPA-specific factors are responsible for the high number of referrals and associated escalating costs. The study culminates in the presentation of practical cost-containment suggestions and policy options.