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Patient choice, entry, and the quality of primary care: Evidence from Swedish reforms

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  • Jens Dietrichson
  • Lina Maria Ellegård
  • Gustav Kjellsson
Abstract
Policies aiming to spur quality competition among health care providers are ubiquitous, but their impact on quality is ex ante ambiguous, and credible empirical evidence is lacking in many contexts. This study contributes to the sparse literature on competition and primary care quality by examining recent competition enhancing reforms in Sweden. The reforms aimed to stimulate patient choice and entry of private providers across the country but affected markets differently depending on the initial market structure. We exploit the heterogeneous impact of the reforms in a difference‐in‐differences strategy, contrasting more and less exposed markets over the period 2005–2013. Although the reforms led to substantially more entry of new providers in more exposed markets, the effects on primary care quality were modest: We find small improvements of patients' overall satisfaction with care, but no consistently significant effects on avoidable hospitalisation rates or satisfaction with access to care. We find no evidence of economically meaningful quality reductions on any outcome measure.

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  • Jens Dietrichson & Lina Maria Ellegård & Gustav Kjellsson, 2020. "Patient choice, entry, and the quality of primary care: Evidence from Swedish reforms," Health Economics, John Wiley & Sons, Ltd., vol. 29(6), pages 716-730, June.
    • Handle: RePEc:wly:hlthec:v:29:y:2020:i:6:p:716-730
    DOI: 10.1002/hec.4015
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    4. 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).
    5. Elina Jussila & Kaisa Kotakorpi & Jouko Verho, 2022. "Prescription behavior of physicians in the public and private sector," Working Papers 5, Finnish Centre of Excellence in Tax Systems Research.
    6. Godager , Geir & Scott, Anthony, 2023. "Physician Behavior and Health Outcomes," HERO Online Working Paper Series 2023:3, University of Oslo, Health Economics Research Programme.
    7. Gustafsson, Per E. & Fonseca-Rodríguez, Osvaldo & Castel Feced, Sara & San Sebastián, Miguel & Bastos, João Luiz & Mosquera, Paola A., 2024. "A novel application of interrupted time series analysis to identify the impact of a primary health care reform on intersectional inequities in avoidable hospitalizations in the adult Swedish populatio," Social Science & Medicine, Elsevier, vol. 343(C).
    8. 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.
    9. Lina Maria Ellegård, 2020. "Effects of pay-for-performance on prescription of hypertension drugs among public and private primary care providers in Sweden," International Journal of Health Economics and Management, Springer, vol. 20(3), pages 215-228, September.
    10. Jeannette Brosig‐Koch & Burkhard Hehenkamp & Johanna Kokot, 2023. "Who benefits from quality competition in health care? A theory and a laboratory experiment on the relevance of patient characteristics," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1785-1817, August.
    11. Ge Ge & Tor Iversen & Oddvar Kaarbøe & Øyvind Snilsberg, 2024. "Impacts of Norway's extended free choice reform on waiting times and hospital visits," Health Economics, John Wiley & Sons, Ltd., vol. 33(4), pages 779-803, April.
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    13. Andersson, Tommy & Ellegård, Lina Maria & Enache, Andreea & Erlanson, Albin & Thami, Prakriti, 2021. "Multiple Pricing for Personal Assistance Services," Working Papers 2021:14, Lund University, Department of Economics, revised 02 May 2024.
    14. Visa Pitkänen, 2022. "Competition and efficiency in repeated procurements: Lessons from the Finnish rehabilitation markets," Health Economics, John Wiley & Sons, Ltd., vol. 31(5), pages 820-835, May.
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    16. Sveréus, Sofia & Petzold, Max & Rehnberg, Clas, 2024. "Change in avoidable hospitalizations for low-income elders following quasi-market reform in primary care – Evidence from a natural experiment in Sweden," Social Science & Medicine, Elsevier, vol. 346(C).

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    JEL classification:

    • D04 - Microeconomics - - General - - - Microeconomic Policy: Formulation; Implementation; Evaluation
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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