Abstract
BackgroundThe organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income.MethodsThe study is based on register data years 2007 – 2011 from the Skåne Regional Council (population 1.2 million) regarding individual health care utilisation in the form of visits to general practitioner (GP). Health utilisation data was matched with data about individual’s age, gender and family income provided by Statistics Sweden. Multilevel, logistic regression models were constructed to analyse changes in health utilisation in different subgroups and the probability of a GP-visit before and after reform.ResultsHealth care utilisation in terms of both number of individuals that had visited a GP and number of GP-visits per capita increased in all defined subgroups, but to a varying degree. Multilevel logistic regression showed that individuals of both genders aged above 64 and belonging to a family with an income above median had more advantage of the reform, OR 1.25-1.29.ConclusionsReforms involving choice and privatisation in Swedish primary health care improved access to GP-visits generally, but more so for individuals belonging to a family with income above the median.
Highlights
The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers
Visits to general practitioner (GP) The inhabitants made a total of 2 161 954 visits to a GP during the years before and a total of 2 386 269 visits after choice was introduced, an absolute rise of 224 315 visits
The effect of interaction between family income above median and choice, i.e. who benefitted most from choice of provider, was highest in the elderly, irrespective of gender. This suggests that improved access to primary care following reform in the Region of Skåne has not been equal in relation to socioeconomic status
Summary
The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income. A wave of primary care reforms involving choice for the population and privatisation of providers was initiated across county councils starting in 2007. Important objectives behind reforms were to strengthen the role of primary health care in general and to improve performance in terms of access and responsiveness to patient expectations [5]. Choice of provider and freedom of establishment for private primary care providers became mandatory for county councils in 2010 through a change in the national
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