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 |