Does competition improve quality? – Empirical evidence from Swedish primary health care
(English)Manuscript (preprint) (Other academic)
Spending on health care makes up a large proportion of the GDP in Sweden as in most developed countries. The introduction of private alternatives and more competition in the market have been advanced as a way to increase efficiency and patient choice, but the previous literature contain conflicting evidence regarding the quality impact of market reforms in health care. This paper examines the impact on health care quality of reforms aimed at introducing more competition in the market for primary health care. The analysis is performed using cross-county variation in private supply and the financial incentives provided by the health care organization in Sweden 1998 to 2010. The analysis separates between measures of quality which are easily observed by patients and measures intended to capture medical quality, which are more difficult for patients to assess. The results indicate that the reforms intended to increase competition do not seem to improve the overall quality of primary health care. Increased competition in the market is associated with more visits to the primary health care, but otherwise, the results give no support for effects on availability or patient satisfaction. The results on clinical quality do not indicate any consistent evidence of any impact of competition either.
IdentifiersURN: urn:nbn:se:uu:diva-205236OAI: oai:DiVA.org:uu-205236DiVA: diva2:640963