Equity aspects of the Primary Health Care Choice Reform in Sweden – a scoping review

International Journal for Equity in Health

Research

Göran Tomson¹  Gunnar Nilsson²  Bo Burström³  Kristina Burström⁴  Margaret Whitehead⁵  Ulrika Winblad⁶ 

[1] Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden;Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden;Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, SE 171 77, Stockholm, Sweden;Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, SE 171 77, Stockholm, Sweden;Department of Learning, Informatics, Management and Ethics, Health Outcomes and Economic Evaluation Research Group, Karolinska Institutet, Stockholm, Sweden;Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, SE 171 77, Stockholm, Sweden;Department of Public Health and Society, Institute of Psychology, Health and Society University of Liverpool, Liverpool, UK;Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden;

关键词: Equity;    Inequalities;    Health care need;    Primary Health Care Choice Reform;    Quality of care;    Reimbursement system;    Resource allocation;   

DOI  :  10.1186/s12939-017-0524-z

 received in 2016-09-21, accepted in 2017-01-20,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundGood health and equal health care are the cornerstones of the Swedish Health and Medical Service Act. Recent studies show that the average level of health, measured as longevity, improves in Sweden, however, social inequalities in health remain a major issue. An important issue is how health care services can contribute to reducing inequalities in health, and the impact of a recent Primary Health Care (PHC) Choice Reform in this respect. This paper presents the findings of a review of the existing evidence on impacts of these reforms.MethodsWe reviewed the published accounts (reports and scientific articles) which reported on the impact of the Swedish PHC Choice Reform of 2010 and changes in reimbursement systems, using Donabedian’s framework for assessing quality of care in terms of structure, process and outcomes.ResultsSince 2010, over 270 new private PHC practices operating for profit have been established throughout the country. One study found that the new establishments had primarily located in the largest cities and urban areas, in socioeconomically more advantaged populations. Another study, adjusting for socioeconomic composition found minor differences. The number of visits to PHC doctors has increased, more so among those with lesser needs of health care. The reform has had a negative impact on the provision of services for persons with complex needs. Opinions of doctors and staff in PHC are mixed, many state that persons with lesser needs are prioritized. Patient satisfaction is largely unchanged. The impact of PHC on population health may be reduced.ConclusionsThe PHC Choice Reform increased the average number of visits, but particularly among those in more affluent groups and with lower health care needs, and has made integrated care for those with complex needs more difficult. Resource allocation to PHC has become more dependent on provider location, patient choice and demand, and less on need of care. On the available evidence, the PHC Choice Reform may have damaged equity of primary health care provision, contrary to the tenets of the Swedish Health and Medical Service Act. This situation needs to be carefully monitored.

【 授权许可】

CC BY   
© The Author(s). 2017