Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T00:46:37.608Z Has data issue: false hasContentIssue false

Choice and privatisation in Swedish primary care

Published online by Cambridge University Press:  12 August 2010

Anders Anell*
Affiliation:
Institute of Economic Research and Department of Business Administration, Lund University School of Economics and Management, Lund, Sweden
*
*Correspondence to: Anders Anell, Institute of Economic Research, Lund University School of Economics and Management, P.O. Box 7080, Lund SE-220 07, Sweden. Email: [email protected]

Abstract

In 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended.

Type
Articles
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anell, A. (2005a), Primärvård i förändring, Lund: Studentlitteratur.Google Scholar
Anell, A. (2005b), ‘Deregulating the pharmacy market: the case of Iceland and Norway’, Health Policy, 75(1): 917.CrossRefGoogle ScholarPubMed
Anell, A. (2008), ‘Vårdval på gång i dagens primärvård. Stora skillnader mellan modeller och stort utvecklingsbehov’, Läkartidningen, 28: 20072010.Google Scholar
Anell, A. (2009), Vårdval i primärvården – Jämförelse av modeller och förutsättningar för konkurrens i sju landsting och regioner, Lund: KEFU.Google Scholar
Baumol, W. J., Panzar, J. C.Willig, R. D. (1982), Contestable Markets and the Theory of Market Structure, New York: Harcourt Brace Jovanovich.Google Scholar
Blomqvist, Å. (1991), ‘The doctor as a double agent: Information asymmetry, health insurance, and medical care’, Journal of Health Economics, 10: 411432.Google Scholar
Devereaux, P. J., Heels-Ansdell, D., Lacchetti, C., et al. (2004), ‘Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis’, CMAJ, 170(12): 18171824.CrossRefGoogle ScholarPubMed
Dixon, J., Holland, P.Mays, N. (1998), ‘Developing primary care: gatekeeping, commissioning, and managed care’, The British Medical Journal, 317: 125128.CrossRefGoogle ScholarPubMed
Ernst & Young (2008), ‘Patientmixens betydelse för effektiviteten hos husläkarmottagningar’. Ernst & Young rapport till Stockholms läns landsting, 2008-06-26.Google Scholar
Exter, A., Hermans, H., Dosljak, M.Busse, R. (2004), Health Care Systems in Transition, Netherlands: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.Google Scholar
Faber, M., Bosch, M., Wollersheim, H., Leatherman, S.Grol, R. (2009), ‘Public reporting in health care: how do consumers use quality-of-care information? A systematic review’, Med Care, 47(1): 18.Google Scholar
Fotaki, M., Roland, M., Boyd, A., McDonald, R., Scheaff, R.Smith, L. (2008), ‘What benefits will choice bring to patients? Literature review and assessment of implications’, J Health Serv Res Policy, 13(3): 178184.CrossRefGoogle ScholarPubMed
Glenngård, A. H., Hjalte, F., Svensson, M., Anell, A.Bankauskaite, V. (2005), Health Systems in Transition: Sweden, Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.Google Scholar
Godber, E., Robinson, R.Steiner, A. (1997), ‘Economic evaluation and the shifting balance towards primary care: definitions, evidence and methodological issues’, Health Economics, 6: 275294.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Gosden, T., et al. (2004), ‘Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians’. Cochrane Database Systematic Review, Issue 2, The Cochrane Library.Google Scholar
Hjelmgren, J.Anell, A. (2007), ‘Population preferences and choice of primary care models: a discrete choice experiment in Sweden’, Health Policy, 82: 314322.CrossRefGoogle Scholar
Hultkrantz, L.Nilsson, J. -E. (2004), Samhällsekonomisk analys, Stockholm: SNS Förlag.Google Scholar
Iversen, T.Lurås, H. (2000), ‘The effect of capitation on GPs referral decisions’, Health Economics, 9: 199210.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Jegers, M., Kesteloot, K., De Graeve, D.Gilles, W. (2002), ‘A typology for provider payment systems in health care’, Health Policy, 60(3): 255273.Google Scholar
Krasnik, A., Groenewegen, P. P., Pedersen, P. A., Scholten, P., Mooney, G., Gottschau, A., Flierman, H. A.Damsgaard, M. T. (1990), ‘Changing remuneration systems: effects on activity in general practice’, British Medical Journal, 360: 16981701.CrossRefGoogle Scholar
Kroneman, M. W., Maarse, H.van der Zee, J. (2006), ‘Direct access in primary care and patient satisfaction: a European study’, Health Policy, 76: 7279.Google Scholar
Lamarche, P. A., et al. (2003), Choices for Change: The Path for Restructuring Primary Healthcare Services in Canada, Ottawa: Canadian Health Services Research Foundation (www.chrsf.ca).Google Scholar
Landstinget Halland (2008), Vårdval Halland – Modellbeskrivning, Halmstad: Landstinget i Halland.Google Scholar
Le Grand, J. (2007), The Other Invisible Hand, Princeton: Princeton University Press.Google Scholar
Majeed, A., Bindman, A. B.Weiner, J. P. (2001), ‘Use of risk adjustment in setting budgets and measuring performance in primary care I: how it works’, The British Medical Journal, 323: 604607.Google Scholar
Miller, H. D. (2009), ‘From volume to value: better ways to pay for health care’, Health Affairs, 28(5): 14181428.CrossRefGoogle ScholarPubMed
Mold, J. W., Fryer, G. E.Roberts, M. (2004), ‘When do older patients change primary care physicians?’, The Journal of the American Board of Family Practice, 17: 453460.CrossRefGoogle ScholarPubMed
Paulsson, G. (2008), Vårdval Halland. Utvärderingsrapport 2007 (unpublished manuscript).Google Scholar
Paulsson, G. (2009), Vårdval Halland. Utvärderingsrapport 2008 (unpublished manuscript).Google Scholar
Rehnberg, C., Janlöv, N.Khan, J. (2009), Uppföljning av Vårdval Stockholm år 2008, Stockholm: Enheten för hälsoekonomi vid Centrum för folkhälsa, Stockholms läns landsting.Google Scholar
Robinson, J. C. (2001), ‘Theory and practice in the design of physician payment incentives’, The Milbank Quarterly, 79(2): 149177.Google Scholar
Saltman, R. B. (2006), ‘Drawing the strands together: primary care in perspective’, in R. B. Saltman, A. Rico and W. Boerma (eds), Primary Care in the Driver’s Seat? Organizational Reform in European Primary Care, Berkshire: Open University Press, 7677.Google Scholar
Saltman, R. B.Busse, R. (2002), ‘Balancing regulation and entrepreneurialism in Europe’s health sector: theory and practice’, in R. B. Saltman, R. Busse and E. Mossialos (eds), Regulating Entrepreneurial Behaviour in European Health Care Systems, Buckingham: Open University Press, 4547.Google Scholar
Saltman, R. B., Rico, A.Boerma, W. (eds) (2006), Primary Care in the Driver’s Seat? Organizational Reform in European Primary Care, Berkshire: Open University Press.Google Scholar
Schlesinger, M.Gray, B. H. (2005), Why Non-Profits Matter in American Medicine: A Policy Brief, Washington: The Aspen Institute.Google Scholar
Scott, A. (2000), ‘Economics of General Practice’, in A. J. Culyer and J. P. Newhouse (eds), Handbook of Health Economics, Volume 1, Amsterdam: Elsevier Sceince, 11811183.Google Scholar
Shapiro, C.Varian, H. (1999), Information Rules, Harvard: Harvard Business School Press.Google Scholar
Stockholms läns landsting (2008), Regelbok för husläkarverksamhet 2008, Stockholm: Stockholms läns landsting.Google Scholar
Stockholms läns landsting (2009), Vårdval Stockholm 2008. Vårdvalsrapport januari – december 2008, Stockholm: Stockholms läns landsting.Google Scholar
Vallgårda, S., Krasnik, A.Vrangbaek, K. (2001), Health Care Systems in Transition: Denmark, Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.Google Scholar
Weller, D. P.Maynard, A. (2004), ‘How general practice is funded in the United Kingdom’, The Medical Journal of Australia, 181(2): 109110.CrossRefGoogle ScholarPubMed
WHO (2001), Health Care Systems in Transition, United Kingdom: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.Google Scholar
WHO (2008), The World Health Report 2008: Primary Health Care: Now More Than Ever, Geneva: World Health Organization.Google Scholar