Abstract
BackgroundA reform in 2010 in Swedish primary care made it possible for private primary care providers to establish themselves freely in the country. In the former, publicly planned system, location was strictly regulated by local authorities. The goal of the new reform was to increase access and quality of health care. Critical arguments were raised that the reform could have detrimental effects on equity if the new primary health care providers chose to establish foremost in socioeconomically prosperous areas.The aim of this study is to examine how the primary care choice reform has affected geographical equity by analysing patterns of establishment on the part of new private providers.MethodsThe basis of the design was to analyse socio-economic data on individuals who reside in the same electoral areas in which the 1411 primary health care centres in Sweden are established. Since the primary health care centres are located within 21 different county councils with different reimbursement schemes, we controlled for possible cluster effects utilizing generalized estimating equations modelling. The empirical material used in the analysis is a cross-sectional data set containing socio-economic data of the geographical areas in which all primary health care centres are established.ResultsWhen controlling for the effects of the county council regulation, primary health care centres established after the primary care choice reform were found to be located in areas with significantly fewer older adults living alone as well as fewer single parents – groups which generally have lower socio-economic status and high health care needs. However, no significant effects were observed for other socio-economic variables such as mean income, percentage of immigrants, education, unemployment, and children <5 years.ConclusionsThe primary care choice reform seems to have had some negative effects on geographical equity, even though these seem relatively minor.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1259-z) contains supplementary material, which is available to authorized users.
Highlights
A reform in 2010 in Swedish primary care made it possible for private primary care providers to establish themselves freely in the country
We investigate what effects the primary care choice reform (PCCR) has had on geographical equity within the Swedish primary health care system by using data from all county councils
The variables are similar to variables used in previous studies of the effects of patient choice reforms and are meant to capture socio-economic status that is related to expected health care needs - e.g., people that are less educated generally have lower health status [46, 47] and people who are unemployed are to a higher degree likely to suffer from depression and anxiety [48]
Summary
A reform in 2010 in Swedish primary care made it possible for private primary care providers to establish themselves freely in the country. In the former, publicly planned system, location was strictly regulated by local authorities. Critical arguments were raised that the reform could have detrimental effects on equity if the new primary health care providers chose to establish foremost in socioeconomically prosperous areas. The aim of this study is to examine how the primary care choice reform has affected geographical equity by analysing patterns of establishment on the part of new private providers. Equity in access to health care services is a central policy goal in most publicly funded health care systems. The increased recognition of this policy challenge in developed countries is underpinned by studies demonstrating the relationship between the geographical proximity of Isaksson et al BMC Health Services Research (2016) 16:28 care, utilization of care services and health outcomes [10,11,12,13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
