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Choice and privatisation in Swedish primary care

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  • Anell, Anders

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.

Suggested Citation

  • Anell, Anders, 2011. "Choice and privatisation in Swedish primary care," Health Economics, Policy and Law, Cambridge University Press, vol. 6(4), pages 549-569, October.
    • Handle: RePEc:cup:hecopl:v:6:y:2011:i:04:p:549-569_00
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    Citations

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    Cited by:

    1. Lina Maria Ellegård & Jens Dietrichson & Anders Anell, 2018. "Can pay‐for‐performance to primary care providers stimulate appropriate use of antibiotics?," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 39-54, January.
    2. Anell, Anders & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2021. "Information, switching costs, and consumer choice: Evidence from two randomised field experiments in Swedish primary health care," Journal of Public Economics, Elsevier, vol. 196(C).
    3. Anell, Anders & Dackehag , Margareta & Dietrichson, Jens, 2016. "Does Risk-Adjusted Payment Influence Primary Care Providers' Decision on Where to Set Up Practices?," Working Papers 2016:24, Lund University, Department of Economics.
    4. Granlund, David & Zykova, Yana, 2020. "Can privatisation of primary care contribute to the spread of antibiotic resistance?," Umeå Economic Studies 977, Umeå University, Department of Economics.
    5. Dahlgren, Cecilia & Dackehag, Margareta & Wändell, Per & Rehnberg, Clas, 2021. "Simply the best? The impact of quality on choice of primary healthcare provider in Sweden," Health Policy, Elsevier, vol. 125(11), pages 1448-1454.
    6. Björn Ekman & Jens Wilkens, 2015. "A literature review of the regional implementation of the central Swedish government’s health care reforms on choice and privatization," Health Economics Review, Springer, vol. 5(1), pages 1-5, December.
    7. Glenngård, Anna Häger, 2013. "Productivity and patient satisfaction in primary care—Conflicting or compatible goals?," Health Policy, Elsevier, vol. 111(2), pages 157-165.
    8. Vengberg, Sofie & Fredriksson, Mio & Winblad, Ulrika, 2019. "Patient choice and provider competition – Quality enhancing drivers in primary care?," Social Science & Medicine, Elsevier, vol. 226(C), pages 217-224.
    9. Sveréus, Sofia & Kjellsson, Gustav & Rehnberg, Clas, 2018. "Socioeconomic distribution of GP visits following patient choice reform and differences in reimbursement models: Evidence from Sweden," Health Policy, Elsevier, vol. 122(9), pages 949-956.
    10. Lapidus, John, 2017. "Private health insurance in Sweden: Fast-track lanes and the alleged attempts to stop them," Health Policy, Elsevier, vol. 121(4), pages 442-449.

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