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Free establishment of primary health careproviders: effects on geographical equity
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, 28Article in journal (Refereed) Published
Abstract [en]

Background

A 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.

Methods

The 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.

Results

When 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.

Conclusions

The primary care choice reform seems to have had some negative effects on geographical equity, even though these seem relatively minor.

Place, publisher, year, edition, pages
2016. Vol. 16, 28
Keyword [en]
Patient choice; Equity; Marketization; Sweden; Primary health care; Geographic location
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:uu:diva-274995DOI: 10.1186/s12913-016-1259-zISI: 000368550800001PubMedID: 26803298OAI: oai:DiVA.org:uu-274995DiVA: diva2:898098
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2016-01-27 Created: 2016-01-27 Last updated: 2017-11-30Bibliographically approved

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Isaksson, DavidBlomqvist, PaulaWinblad, Ulrika

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