Free establishment of primary health care providers: effects on geographical equity

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.

Referring to multimodal rehabilitation for patients with musculoskeletal disorders – a register study in primary health care

“…The accessibility of health care services varies with geographical location, due to distances but also due to fewer options to choose care providers in less populated areas [26–28]. In Sweden fewer new PHCCs are established in areas with lower socio-economic status [26].…”

“…In Sweden fewer new PHCCs are established in areas with lower socio-economic status [26]. Geographical related access to PHC might therefore impact referral to MMR [26].…”

“…In Sweden fewer new PHCCs are established in areas with lower socio-economic status [26]. Geographical related access to PHC might therefore impact referral to MMR [26]. Studies have shown that PHCCs size may affect access to health care and how patients experience the quality of healthcare regarding accessibility of care, consultation length and continuity [29, 30].…”

“…In a Swedish report the proportion of various referrals per PHCC varied with unit size [30]. New PHCCs in Sweden are almost exclusively privately operated and are established primarily in urban areas [26]. The introduction of freedom of choice in PHC has shifted care to become more customer-oriented [31].…”

Risks and Opportunities of Reforms Putting Primary Care in the Driver’s Seat Comment on "Governance, Government, and the Search for New Provider Models"

“…2,7 Inequity is not considered a problem, but some observations are made that new providers seem to avoid areas with complex care needs. 9 The aim to get more and stronger non-profit actors is far from being materialized 1,2 instead most providers are profitdriven companies with several of the big actors having foreign owners. 10 Consequently, the entire system and its dynamics tend to be under transition.…”