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Patient choice and provider competition: Quality enhancing drivers in primary care?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.ORCID iD: 0000-0003-4715-4851
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.ORCID iD: 0000-0002-3858-3454
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.ORCID iD: 0000-0002-3921-5522
2019 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 226, p. 217-224Article in journal (Refereed) Published
Abstract [en]

Patient choice of provider and provider competition have been introduced with the claim that they would lead to improved quality. For this to occur, certain conditions must be fulfilled on both the demand and the supply side. However, supply side-mechanisms – with provider behaviour as central – have been largely neglected in the literature, especially in primary care markets. In this article, we focus on provider behaviour and explore if and how choice and competition function as quality enhancing drivers in Swedish primary care. We explore this through semi-structured interviews with 24 managers and physicians at 13 Swedish primary healthcare centres, conducted from May 2016 to February 2017. The analysis draws on assumptions that for enhanced quality, providers must receive information on patients' choices, analyse it and respond accordingly. One conclusion is that Swedish primary care providers lack information on patients' choices and "exits", which makes it difficult for providers to respond to patients' choices. Furthermore, it is questionable whether choice and competition stimulate enhanced clinical quality. At the same time, choice and competition seems to make providers more aware of accessibility concerns and of their reputation, which they may be stimulated to improve. The article contributes evidence on supply side-mechanisms, and encourages clarification of "quality" in this respect, both on the political arena as well as in theoretical models.

Place, publisher, year, edition, pages
2019. Vol. 226, p. 217-224
Keywords [en]
Sweden, Patient choice, Competition, Quasi-market, Primary care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:uu:diva-379412DOI: 10.1016/j.socscimed.2019.01.042ISI: 000466251700025PubMedID: 30878640OAI: oai:DiVA.org:uu-379412DiVA, id: diva2:1296525
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4763Available from: 2019-03-15 Created: 2019-03-15 Last updated: 2019-06-20Bibliographically approved

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Vengberg, SofieFredriksson, MioWinblad, Ulrika

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