Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits

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.

Influence of self‐care advice on patient satisfaction and healthcare utilization

“…). According to Beckman and Anell (), demand and expectations of welfare services will increase in pace with increases in the gross domestic product and household disposable income, as availability drives demand. However, most symptoms of illness are not presented to healthcare services (Elliott et al .…”

“…It is also economically beneficial for strained healthcare organizations to direct the management of minor illnesses away from high-cost settings . According to Beckman and Anell (2013), demand and expectations of welfare services will increase in pace with increases in the gross domestic product and household disposable income, as availability drives demand. However, most symptoms of illness are not presented to healthcare services (Elliott et al 2011), and minor illness is often managed through self-care interventions like watchful waiting, self-medication and rest (Gustafsson et al 2015a).…”

Private ownership of primary care providers associated with patient perceived quality of care

“…[19,40] A study in Sweden showed that privatization of primary care providers improved patient accessibility, but only among people of high income. [7] …”

“…[4] Studies in Sweden, US, and Eastern European Countries demonstrated that privatization of healthcare has reduced public health service and care accessibility for vulnerable populations, diverting money to profitable services, and eventually driving up healthcare costs. [5–7] …”

Variations in older people’s use of general practitioner consultations and the relationship with mortality rate in Vantaa, Finland in 2003–2014

“…In the period from 1997 to 2005, for the whole of Finland, there was a constant decrease in the number of visits to GPs in health centers per inhabitant over 65 years of age per year: from 4.3 (in 1997) to 3.2 visits per inhabitant (in 2005) [14], whereas in 2009 the same age group had only a mean of 2.4 GP visits per year [15]. In a Swedish study, over-65-year-old men had an average of 3.4-3.8 GP visits per year and women 4.2-4.5 GP visits per year in 2007-2011 [16]. The official statistics of Finnish health care services revealed that in 2001 the total number of visits to primary health services was 25,000,000.…”