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Choosing not to choose - patients’ justification of a disengaged choice of primary care provider
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Hälso- och sjukvårdsforskning)ORCID iD: 0000-0002-5816-1857
Institutionen för journalistik, medier och kommunikation JMG, Göteborgs universitet.ORCID iD: 0000-0002-9182-4536
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Hälso- och sjukvårdsforskning)ORCID iD: 0000-0002-3921-5522
Akademin för hälsa, vård och välfärd , Avdelningen för vårdvetenskap och vårdpedagogik, Mälardalens universitet.ORCID iD: 0000-0002-4302-5529
2023 (English)In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 57, no 7, p. 1014-1031Article in journal (Refereed) Published
Abstract [en]

A key underpinning of choice of health care provider is that patients make active and informed decisions which stimulate quality competition. By imitating the principles of a market in the steering of health care, patients thus assume the role of consumers. Few patients however neither consider alternative providers nor seek information about quality. The aim of this study was to investigate if and how patients engage in the role of being active and informed consumers in the setting of primary care, and how they argue for their choice. The study was based on semi-structured interviews with 18 respondents in a municipality in mid-Sweden. Respondents were purposefully sampled and interviews were analysed using an inductive thematic approach. Findings demonstrated that patients disengaged from choice by arguing, for instance, that they were satisfied with their current provider or because they perceived no differences in quality. Overall, results were in line with previous studies performed in US and European hospital settings, indicating that patients present some similar arguments regarding disengagement from choice irrespective of level of care or geographical setting. Arguments specifically related to the primary care level were that patients found it more important to achieve continuity in the patient-doctor relationship than ‘shopping around’ for the best provider, or that they desired more profiled services to actively make a choice. In contrast to previous literature, patients refuted the ‘patient-consumer’ role by referring to, for instance, the belief that care should be of equal quality independent of what choice they made.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023. Vol. 57, no 7, p. 1014-1031
Keywords [en]
Provider choice, Patient choice, Information search, Public reporting, Primary care, Pragmatic Sociology of Critique, Thematic analysis, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health Care Research
Identifiers
URN: urn:nbn:se:uu:diva-470627DOI: 10.1111/spol.12915ISI: 000978598700001OAI: oai:DiVA.org:uu-470627DiVA, id: diva2:1647453
Available from: 2022-03-28 Created: 2022-03-28 Last updated: 2024-02-27Bibliographically approved
In thesis
1. Informed patient choice – chimera or reality?: Understanding how patients engage in information-seeking when choosing a provider in Swedish primary care
Open this publication in new window or tab >>Informed patient choice – chimera or reality?: Understanding how patients engage in information-seeking when choosing a provider in Swedish primary care
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The steering of health care through patient choice has become an integral part of several health systems. In Sweden, the government introduced a legal right for patients to choose their own primary care provider in 2010. The reform was built on the principles of a quasi-market, meaning that public reimbursement follows patients’ choices to stimulate both public and private providers to compete for patients. Through this the government hoped to achieve higher quality and efficiency of services as large groups of patients were assumed to seek care from the best performing providers. An important precondition of a functioning quasi-market such as the patient choice is that patients make informed choices. By this is implied that they consider the service quality of different providers by actively seeking and using relevant and reliable information. Otherwise, the mechanism behind patient choice might be lost as providers will not be exposed of the risk of being outcompeted due to inferior quality. The specific aim of this thesis was to investigate how patients engage with the assumptions of the informed choice of a primary care provider and the conditions that influence them in this regard. This aim was achieved by conducting four empirical studies. The main findings of the studies demonstrated that not even patients in active choice situations, as they had switched or considered switching primary care provider, searched for information which could underpin a judgment of the quality of different providers. Findings indicated that patients’ overall lack of engagement in making informed choices was the result of how they experienced the conditions of choice, such as a lack of promoted differences in the range and quality of services and a general trust in that they would receive health care of equal quality regardless of choice. Patients also actively resisted the very premises of an informed choice by arguing that the convenience of being geographically close to services was more important than opting for the clinically best provider, or that access to primary care services of high quality should not be dependent on making an informed choice. The results implicate that patients’ choices have poor prospects of function as drivers of quality, and that public authorities must continue to safeguard quality to ensure that all patients receive an acceptable standard of primary care services.   

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2022. p. 68
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1829
Keywords
patient choice, choice of provider, informed choice, information seeking, primary care, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-470629 (URN)978-91-513-1465-5 (ISBN)
Public defence
2022-05-20, Sal IX, Universitetshuset, Biskopsgatan 3, 753 10, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2022-04-29 Created: 2022-03-30 Last updated: 2022-06-14

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Hoffstedt, CarolineWinblad, Ulrika

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