| 1. |
- Ellegård, Lina Maria Maria, et al.
(författare)
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Enabling patient-physician continuity in Swedish primary care : the importance of a named GP
- 2024
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Ingår i: BJGP Open. - : Royal College of General Practitioners. - 2398-3795.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND : Continuity of care is important for patients with chronic conditions. Assigning patients to a named GP may increase continuity. AIM : To examine if patients who were registered with a named GP at the onset of their first chronic disease had higher continuity at subsequent visits than patients who were only registered at a practice. DESIGN & SETTING : Registry-based observational study in Region Skåne, Sweden. The study population included 66,063 patients registered at the same practice at least 1 year before the first chronic condition onset in 2009-2015. METHOD : We compared patients registered with a named GP with patients only registered at a practice over a four-year follow-up period. The primary outcome was the Usual Provider of Care (UPC) index, for all visits and for visits related to the chronic disease. Secondary outcomes were the number of GP, nurse and out-of-hours visits, ED visits, hospital admissions, and mortality. We used linear regression models, adjusted for patient characteristics (using entropy balancing weights) and for practice-level fixed effects. RESULTS : Patients with a named GP at onset had 3-4 percentage points higher UPC, but the difference decreased and was not statistically significant after adjusting for patient and practice characteristics. Patients with a named GP made more visits, though not for the chronic condition. There were no statistically significant differences for the other outcomes. CONCLUSION : Registration with a GP at onset does not imply higher continuity at visits and is not linked to other relevant outcomes for patients diagnosed with their first chronic condition.
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| 2. |
- Ellegård, Lina Maria Maria, et al.
(författare)
-
Enabling patient-physician continuity in Swedish primary care : the importance of a named GP
-
Ingår i: BJGP open. - 2398-3795.
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Continuity of care is important for patients with chronic conditions. Assigning patients to a named GP may increase continuity.AIM: To examine if patients who were registered with a named GP at the onset of their first chronic disease had higher continuity at subsequent visits than patients who were only registered at a practice.DESIGN & SETTING: Registry-based observational study in Region Skåne, Sweden. The study population included 66,063 patients registered at the same practice at least 1 year before the first chronic condition onset in 2009-2015.METHOD: We compared patients registered with a named GP with patients only registered at a practice over a four-year follow-up period. The primary outcome was the Usual Provider of Care (UPC) index, for all visits and for visits related to the chronic disease. Secondary outcomes were the number of GP, nurse and out-of-hours visits, ED visits, hospital admissions, and mortality. We used linear regression models, adjusted for patient characteristics (using entropy balancing weights) and for practice-level fixed effects.RESULTS: Patients with a named GP at onset had 3-4 percentage points higher UPC, but the difference decreased and was not statistically significant after adjusting for patient and practice characteristics. Patients with a named GP made more visits, though not for the chronic condition. There were no statistically significant differences for the other outcomes.CONCLUSION: Registration with a GP at onset does not imply higher continuity at visits and is not linked to other relevant outcomes for patients diagnosed with their first chronic condition.
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| 3. |
- Andersson, Tommy, et al.
(författare)
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Multiple Pricing for Personal Assistance Services
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper provides a general theoretical framework that captures the essential features ofa Swedish reform where private and public health care providers serve patients with certainfunctional impairments. Because providers receive a fixed hourly compensation for theirservices (identical across patient types) and only private providers can reject service requestsfrom patients, private providers avoid the costliest patients, resulting in a monetary deficitfor public providers. To partially overcome this problem, a multiple pricing (reimbursement)scheme is proposed and its solution is characterized. The results suggest that there are somefundamental trade-offs, e.g., between the goals of containing costs and restricting choicesfor patients, but that the suggested pricing scheme may substantially reduce the deficits forpublic providers without affecting the total budget set by the central government.
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| 4. |
- Anell, Anders, et al.
(författare)
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Access to automated comparative feedback reports in primary care : a study of intensity of use and relationship with clinical performance among Swedish primary care practices
- 2024
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Digital applications that automatically extract information from electronic medical records and provide comparative visualizations of the data in the form of quality indicators to primary care practices may facilitate local quality improvement (QI). A necessary condition for such QI to work is that practices actively access the data. The purpose of this study was to explore the use of an application that visualizes quality indicators in Swedish primary care, developed by a profession-led QI initiative (“Primärvårdskvalitet”). We also describe the characteristics of practices that used the application more or less extensively, and the relationships between the intensity of use and changes in selected performance indicators. Methods: We studied longitudinal data on 122 primary care practices’ visits to pages (page views) in the application over a period up to 5 years. We compared high and low users, classified by the average number of monthly page views, with respect to practice and patient characteristics as well as baseline measurements of a subset of the performance indicators. We estimated linear associations between visits to pages with diabetes-related indicators and the change in measurements of selected diabetes indicators over 1.5 years. Results: Less than half of all practices accessed the data in a given month, although most practices accessed the data during at least one third of the observed months. High and low users were similar in terms of most studied characteristics. We found statistically significant positive associations between use of the diabetes indicators and changes in measurements of three diabetes indicators. Conclusions: Although most practices in this study indicated an interest in the automated feedback reports, the intensity of use can be described as varying and on average limited. The positive associations between the use and changes in performance suggest that policymakers should increase their support of practices’ QI efforts. Such support may include providing a formalized structure for peer group discussions of data, facilitating both understanding of the data and possible action points to improve performance, while maintaining a profession-led use of applications.
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| 5. |
- Anell, Anders, et al.
(författare)
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Better off by risk adjustment? : Socioeconomic disparities in care utilization in Sweden following a payment reform
- 2024
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Ingår i: Journal of Policy Analysis and Management. - : Wiley-Liss Inc.. - 0276-8739 .- 1520-6688.
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Tidskriftsartikel (refereegranskat)abstract
- Reducing socioeconomic health inequalities is a key goal of most health systems. A challenge in this regard is that healthcare providers may have incentives to avoid or undertreat patients who are relatively costly to treat. Due to the socioeconomic gradient in health, individuals with low socioeconomic status (SES) are especially likely to be negatively affected by such attempts. To counter these incentives, payments are often risk adjusted based on patient characteristics. However, empirical evidence is lacking on how, or if, risk adjustment affects care utilization. We examine if a novel risk adjustment model in primary care affected socioeconomic differences in care utilization among individuals with a chronic condition. The new risk adjustment model implied that the capitation—the monthly reimbursement paid by the health authority to care providers for each enrolled patient—increased substantially for chronically ill low-SES patients. Yet, we do not find any robust evidence that their access to primary care improved relative to patients with high SES, and we find no effects on adverse health events (hospitalizations). These results suggest that the new risk adjustment model did not reduce existing health inequalities, indicating the need for more targeted incentives and interventions to reach low-SES groups.
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| 6. |
- Anell, Anders, et al.
(författare)
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Better Off by Risk Adjustment? Socioeconomic Disparities in Care Utilization in Sweden Following a Payment Reform
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Reducing socioeconomic health inequalities is a key goal of most health systems. When care providers are paid prospectively, e.g., by a fixed sum per patient, existing inequalities may be sustained by the incentives to undertreat relatively unhealthy patients. To counter these incentives, prospective payments are often risk-adjusted based on observable patient characteristics. Despite that risk adjustment (RA) is widely used, empirical evidence is lacking on how it affects the behavior of care providers. This paper provides such evidence using detailed administrative data from a Swedish region. We examine how a novel RA model applied to the prospective payment for primary care providers – capitation – affected socioeconomic differences in care utilization among individuals with a chronic condition. On average, the new RA model implied substantial increases of the capitation for patients with low socioeconomic status (SES). Yet, we do not find any robust evidence of greater access to primary care for individuals with low SES relative to individuals with high SES after the model was introduced. We find a small increase in hospital emergency department visits (a substitute to primary care), but no effects on hospitalizations. These results do not suggest that the new RA model reduced socioeconomic health inequalities. Our findings highlight that a risk-adjusted prospective payment may not by itself guide treatment decisions. We discuss other governance and management policies that may address undesired health inequalities.
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| 7. |
- Anell, Anders, et al.
(författare)
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Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?
- 2015
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Resistance to antibiotics is a major threat to the effectiveness of modern health care. This study examines if pay-for-performance (P4P) to care providers stimulates the appropriate use of antibiotics; in particular, if P4P can induce a substitution away from broad-spectrum antibiotics, which contribute more to the development of resistance, to less resistance-driving types. In the context of Swedish primary care, we study the introduction of P4P indicators encouraging substitution of narrow-spectrum antibiotics for broad-spectrum antibiotics in the treatment of children with respiratory tract infections (RTI). During 2006-2013, 8 out of 21 county councils introduced such P4P indicators in their reimbursement schemes for primary care providers. We employ municipality-level register data covering all purchases of RTI related antibiotics and exploit the staggered introduction of pay-for-performance in a difference-in-differences analysis. Despite that the monetary incentives were small, we find that P4P significantly increased narrow-spectrum antibiotics' share of RTI antibiotics consumption. We further find larger effects in areas where there were many private providers, where the incentive was formulated as a penalty rather than a reward, and where all providers were close to a P4P target.
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| 8. |
- Anell, Anders, et al.
(författare)
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Information, switching costs, and consumer choice: Evidence from two randomised field experiments in Swedish primary health care
- 2021
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Ingår i: Journal of Public Economics. - : Elsevier BV. - 0047-2727. ; 196
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Tidskriftsartikel (refereegranskat)abstract
- Consumer choice policies may improve the matching of consumers and providers, and may spur competition over quality dimensions relevant to consumers. However, the gains from choice may fail to materialise in markets characterised by information frictions and switching costs. We use two large-scale randomised field experiments in primary health care to examine if individuals reconsider their provider choice when receiving leaflets with comparative information and pre-paid choice forms by postal mail. The first experiment targeted a representative subset of the 1.3 million residents in a Swedish region. The second targeted new residents in the same region, a group expected to have less prior information and lower switching costs than the general population. The propensity to switch providers increased after the interventions in both the population-representative sample (by 0.6–0.8 percentage points, 10–14%) and among new residents (2.3 percentage points, 26%). The results demonstrate that there are demand side frictions in the primary care market. Exploratory analyses indicate that the effects on switching were larger in urban markets and that the interventions had heterogeneous effects on the type of providers chosen, and on health care and drug consumption.
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| 9. |
- Anell, Anders, et al.
(författare)
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Information, Switching Costs, and Consumer Choice : Evidence from Two Randomized Field Experiments in Swedish Primary Health Care
- 2017
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Consumers of services that are financed by a third party, such as publicly financed health care or firm-sponsored health plans, are often allowed to freely choose provider. The rationale is that consumer choice may improve the matching of consumers and providers and spur quality competition. Such improvements are contingent on consumers having access to comparative information about providers and acting on this information when making their choice. However, in the presence of information frictions and switching costs, consumers may have limited ability to find suitable providers. We use two large-scale randomized field experiments in primary health care to examine if the choice of provider is affected when consumers receive comparative information by postal mail and small costs associated with switching are reduced. The first experiment targeted a subset of the general population in the Swedish region Skåane, and the second targeted new residents in the region, who should have less prior information and lower switching costs. In both cases, the propensity to switch provider increased significantly after the intervention. The effects were larger for new residents than for the general population, and were driven by individuals living reasonably close to alternative providers.
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| 10. |
- Anell, Anders, et al.
(författare)
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Weak association between socioeconomic Care Need Index and primary care visits per registered patient in three Swedish regions
- 2021
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:3, s. 288-295
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status.DESIGN: Observational study combining graphical analysis with linear regressions of cross-sectional administrative practice-level data.SETTING: Three Swedish regions, Västra Götaland, Skåne and Östergötland (3.5 million residents). Outcomes were measured in February 2018 and the CNI was computed based on data for 31 December 2017.SUBJECTS: The unit of analysis was the primary care practice (n = 390).MAIN OUTCOME MEASURES: i) Number of GP visits per registered patient; ii) Number of nurse visits per registered patient; iii) Number of morbidity-weighted GP visits per registered patient; iv) Number of morbidity-weighted nurse visits per registered patient.RESULTS: The linear associations between the CNI and GP visits per patient were positive and statistically significant (p<0.01) for both the unweighted and weighted measure in two regions, but the associations were mainly due to 10 practices with very high CNI values. The results for nurse visits varied across regions.CONCLUSIONS: For most levels of the CNI, there was no association with the number of consultations provided. This result may indicate insufficient compensation, weak incentives to spend the money, decisions to spend the money on other things than consultations, or stronger competition for patients among low-CNI practices. The result of this observational study should not be taken as evidence against the possibility that the CNI adjustment of capitation may have affected the socioeconomic equity in GP and nurse visits.Key PointsSwedish primary care practices receive extra compensation for socioeconomically deprived patients but it is unknown how this affects service provision.Practice-level data from three regions years 2017-2018 indicate weak or no relation between the socioeconomic burden and the number of physical consultations per patient.Results are similar when adjusting for patients' morbidity levels, suggesting that the weak gradient was not explained by longer consultations.The exception is that a small number of practices with very high burdens provide more consultations per patient.The results may reflect insufficient compensation, lack of incentives, or funds being spent on other things than consultations.
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