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Open Access Research article

Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits

Anders Beckman1* and Anders Anell2

Author Affiliations

1 Faculty of medicine, Lund University, IKVM Allmänmedicin, Jan Waldenströmsgata 35, Skånes universitetssjukhus, Malmö SE-205 02, Sweden

2 Institute of Economic Research, Lund University School of Economics and Management, P.O. Box 7080, Lund SE- 220 07, Sweden

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BMC Health Services Research 2013, 13:452  doi:10.1186/1472-6963-13-452

Published: 31 October 2013

Abstract

Background

The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income.

Methods

The study is based on register data years 2007 – 2011 from the Skåne Regional Council (population 1.2 million) regarding individual health care utilisation in the form of visits to general practitioner (GP). Health utilisation data was matched with data about individual’s age, gender and family income provided by Statistics Sweden. Multilevel, logistic regression models were constructed to analyse changes in health utilisation in different subgroups and the probability of a GP-visit before and after reform.

Results

Health care utilisation in terms of both number of individuals that had visited a GP and number of GP-visits per capita increased in all defined subgroups, but to a varying degree. Multilevel logistic regression showed that individuals of both genders aged above 64 and belonging to a family with an income above median had more advantage of the reform, OR 1.25-1.29.

Conclusions

Reforms involving choice and privatisation in Swedish primary health care improved access to GP-visits generally, but more so for individuals belonging to a family with income above the median.

Keywords:
Primary care; Health care utilisation; Equity; Choice; Privatisation; Sweden