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Table 2 Overview of potential and observed effects of the PHC Choice reform and reimbursement systems on structure, process and outcome in PHC in Sweden

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

 

PHC Choice Reform

Reimbursement system based on fee-for service

Comments - impact on equity and need-based care

Structure - Access, resources

 Number of practices

Increased

 

Less increase in disadvantaged areas

 Practice distribution

Providers’ choice determines practice distribution

 

Reduced political influence on distribution by need, may cause maldistribution

 Resource allocation

Patients’ choice determines resource allocation between practices

Short visits are incentivised = more income

Reduced political influence on resource allocation by need

 GP’s work environment

Patients become customers - change in professional focus

Many short visits are incentivised

Priority on those with lesser needs

Process - Delivery of health care

 Number of visits to PHC

Increased

Increased

Greater increase for those with lesser needs

 Prioritisation of patients

Patients as customers

Focus on short visits by healthier patients

More demand-driven care. Less focus on those with greater need

 Integrated care

More complex to achieve integration, competition

Integrated care not incentivised

More difficult for those in need of integrated care

 Holistic care

De-limited, differentiated PHC assignments (e.g. ENT, gynaecology, child health)

One visit, one problem (short itemized visits)

Itemized care not beneficial for those with complex needs

 Inter-professional care

Focus on doctors

Less teamwork doctors and nurses

No benefit for those in need of inter-professional care

Outcomes – impact on health

 Health among those with complex needs

Coordination and integration more difficult

Counteracts holistic care

Potentially adverse effects on those with greater needs

 Treatment impact

Reduced focus on prevention, more emphasis on cure

Focus on short visits - curative care for self-limiting diseases

Increase in preventable health problems?

 Population health

Focus only on listed individuals limits population impact

Less emphasis on health promotion and on collaboration with other agencies

Reduces PHC impact on population health