Table 1 List of reviewed publications
From: Equity aspects of the Primary Health Care Choice Reform in Sweden – a scoping review
Publication | Ref. no. | Year | Area(s) | Data | Focus | Results |
|---|---|---|---|---|---|---|
Scientific articles | ||||||
Beckman, Anell | [23] | 2013 | Region Skåne | Population register data | Process of care – PHC visits | Visits increased more among high-income than low income earners |
Agerholm et al | [25] | 2015 | Stockholm County council | Population register data, public health survey data | Process of care – PHC visits | Visits increased more among person with lesser needs; less among those with greater needs |
Glenngård | [32] | 2013 | Region Halland, Skåne, Västra Götaland | Patient survey data | Outcome – Patient satisfaction | Satisfaction with primary care higher in areas with low level of social deprivation and in smaller practices |
Maun et al | [27] | 2013 | Gothenburg | Interviews with 24 PHC managers | Process of care – doctors’ views | Prioritisation conflicts among doctors between patients with different needs and demands. Chronically ill patients were crowded out. |
Hollman et al | [28] | 2014 | Gothenburg | Interviews with PHC district nurses | Process of care – nurses’ views | Reimbursement system emphasizes doctors and plays down nurses’ role. Negative for job satisfaction and work environment |
Isaksson et al | [17] | 2016 | Nationwide | Area socioeconomic composition of population in relation to established clinics | Structure – establishment of new practices | New centres located in areas with fewer old adults living alone and fewer single parents. No significant effects of income, percentage immigrants, education, unemployment |
“Grey literature” | ||||||
Rehnberg et al | [21] | 2008 | Stockholm County council | Population register data | Visits, productivity, resource allocation | Increase in visits and in productivity overall. Resources decreased in areas with greater need |
Glenngård | [31] | 2012 | Region Halland, Region Skåne, Region Västra Götaland | Patient survey data | Outcome - Patient satisfaction | Satisfaction with primary care higher in areas with low level of social deprivation and in smaller practices |
Swedish Association of Local Authorities and Regions | [19] | 2012 | Nationwide | Survey among 360 PHC managers | Doctors’ views on reform and reimbursement systems | Dissatisfaction with reimbursement systems, leading to prioritization of patients with lesser needs |
Johansson | [30] | 2012 | Stockholm County Council | Survey among PHC doctors and nurses | Health promotion in PHC | Negative impact on health promotion because of lack of reimbursement |
Dahlgren et al | [24] | 2013 | Stockholm County Council | Population register data | Visits, patient satisfaction, new practices | Increase in visits for all but more among high income earners. Patient satisfaction generally not affected, but lower among patients with greater needs. New practices spread out. |
Mohmand | [29] | 2014 | Stockholm County Council | Interviews with 6 PHC doctors | Process of care – doctors’ views | PHC reform makes patients to be customers Reimbursement system prioritises those with lesser needs |
National Audit Office | [18] | 2014 | Nationwide, three county councils in-depth | Population register data, interviews | Structure – establishment of new practices | More new practices in wealthy larger urban areas, interviews suggesting practitioners not establishing in areas with greater need |
Myndigheten för vårdanalys | [26] | 2015 | Stockholm County Council, Region Västra Götaland, Region Östergötland | Population register data | Process of care – PHC visits | Increase in visits among all, stronger among high income earners. Higher increase among person with no diagnosis indicating higher health care need. |
Government investigation “Efficient care” | [10] | 2016 | Nationwide | Meetings, interviews, documents | Organization of health care, role of PHC | PHC very important to the whole health care system, should be first line for all. PHC Choice Reform has made cooperation around patients with complex needs more difficult. Suggest legislation for separate organization of PHC for these patients. |