| 1. |
- Fredriksson, Mio, 1976-, et al.
(författare)
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Fifteen years with patient choice and free establishment in Swedish primary healthcare : what do we know?
- 2022
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 50:7, s. 852-863
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2007, a reform of Swedish primary healthcare began when some regions implemented enhanced patient choice in combination with free establishment for private providers. Although heavily debated, in 2010 it became mandatory for all regions to implement this choice system.Aim: The aim of this article was to review all published research articles related to the primary healthcare choice reform in Sweden, to investigate what has been published about the reform and summarise its first 15 years.Methods: A scoping review was performed to cover the breadth of research on the reform. Searches were made in Scopus, Web of Science and PubMed for articles published between 2007 and 2021, resulting in 217 unique articles. In total, 52 articles were included. Results: The articles were summarised and presented in relation to six overarching themes: arguments about the primary healthcare choice reform; governance and financial reimbursements; choice of provider and use of information; effects on equity and access; effects on quality; and differences between private and public primary healthcare centres.Conclusions: The articles show that the reform has led to an increase in access to primary healthcare, but most studies indicate that the increase is inequitably distributed in terms of socioeconomy and geographical location. The effects on quality are unclear but several studies show that the mechanisms supposed to lead to quality improvements do not work as intended. Furthermore, from a population health perspective, it is time to discuss how such a responsibility can be reintegrated into primary healthcare and function with the choice system.
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| 2. |
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| 3. |
- Isaksson, David, 1982-, et al.
(författare)
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Privatization of social care delivery : how can contracts be specified?
- 2018
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Ingår i: Public Management Review. - : Informa UK Limited. - 1471-9037 .- 1471-9045. ; 20:11, s. 1643-1662
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Tidskriftsartikel (refereegranskat)abstract
- When contracting out services to private actors, public authorities must be able to ensure that the quality of services provided is satisfactory. Therefore, it is important to formulate precise quality requirements, thus making them possible to monitor. In the study, 1,005 quality requirements from public procurements of nursing homes were categorized, and their degree of monitorability assessed. The analysis showed that quality requirements related to soft' areas such as social activities typically were non-monitorable. The requirements were written in an imprecise, vague manner, thus making it difficult for the local governments to determine whether or not they were met.
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| 4. |
- Isaksson, David, 1982-, et al.
(författare)
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Risk selection in primary care : a cross-sectional fixed effect analysis of Swedish individual data
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:10
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess socioeconomic differences between patients registered with private and public primary healthcare centres.Design Population-based cross-sectional study controlling for municipality and household.Setting Swedish population-based socioeconomic data collected from Statistics Sweden linked with individual registration data from all 21 Swedish regions.Participants All individuals residing in Sweden on 31 December 2015 (n=9 851 017) were included in the study.Primary outcome measures Registration with private versus public primary healthcare centres.Results After controlling for municipality and household, individuals with higher socioeconomic status were more likely to be registered with a private primary healthcare provider. Individuals in the highest income quantile were 4.9 percentage points (13.7%) more likely to be registered with a private primary healthcare provider compared with individuals in the lowest income quantile. Individuals with 1–3 years of higher education were 4.7 percentage points more likely to be registered with a private primary healthcare provider compared with those with an incomplete primary education.Conclusions The results show that there are notable differences in registration patterns, indicating a skewed distribution of patients and health risks between private and public primary healthcare providers. This suggests that risk selection behaviour occurs in the reformed Swedish primary healthcare system, foremost through location patterns.
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| 5. |
- Isaksson, David, 1982-
(författare)
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Steering health and social care through quasi-markets
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Municipalities and county councils try a multitude of different strategies when they design and steer health and social care markets to ensure that goals such as quality and equity are met. Depending on the strategies used, different problems arise. The aim of this thesis is to examine how local authorities can design quasi-markets in a way that achieves public goals such as equity and high quality. To answer the aim, four empirical studies were carried out.The studies show that when designing a market by contracting-out through public procurement, the issues lay primarily at specifying and defining what is meant by quality before a service is privatized. This is especially difficult to do concerning soft areas such as elder- and healthcare. If this is not done properly, it can lead to crucial issues for monitoring quality since the contracting authority cannot hold the provider responsible for delivering an aspect of a service if that aspect is not specified in the contract.When a market is designed as in the patient choice systems in primary care, it creates a whole other set of difficulties for the local governments. Here, it is not as important to specify quality beforehand in the contracts since quality monitoring is done retrospectively by both the counties themselves as well as the patients who with their choices can monitor quality by punishing providers with poor quality by registering with another provider. Instead, the crucial problem is how to design reimbursement system that will lead to an equal access to health care. In this respect, the county councils utilize different methods. However, despite these measures, the primary care choice reform have led to inequity, both geographical inequity in regards to where new private primary health care centres are located but also, to a larger degree, socio-economic inequity relating to what kind of socio-economic groups of individuals are registered with private PHCCs. In other words, county councils do not manage to fully counteract risk selection behaviour by the design of their reimbursement system which could imply issues with unequal access to health care.
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| 6. |
- Johansson, Nina, et al.
(författare)
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Ameliorating Child poverty through Connecting Economic Services with child health Services (ACCESS) : study protocol for a randomised controlled trial of the healthier wealthier families model in Sweden
- 2022
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSweden is often held up as an example of a country with low child deprivation; yet, rates of relative deprivation are rising. Every municipality in Sweden is required to provide free, timely and accessible budget and debt counselling under the Social Services Act. The services have been encouraged to perform preventative practice with families; however, this has not been realised. The Healthier Wealthier Families (HWF) model embeds universal screening for economic hardship into child health services and creates a referral pathway to economic support services. Given the universal child health system in Sweden, which is freely available and has excellent coverage of the child population, implementation of the HWF model has potential to support families to access the freely available municipal budget and debt counselling and ultimately improve rates of child deprivation in Sweden.Methods/designWe will conduct a two-arm randomised waitlist-control superiority trial to examine the effectiveness and cost-effectiveness of the HWF model in the Sweden. A longitudinal follow-up with the cohort will explore whether any effects are maintained in the longer-term.DiscussionHWF is a collaborative and sustainable model that could maximise the effectiveness of current services to address child deprivation in Sweden. The study outlined in this protocol is the first effectiveness evaluation of the HWF model in Sweden and is a crucial step before HWF can be recommended for national implementation within the child health services.
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| 7. |
- Landin, Per Niklas, et al.
(författare)
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Wideband Characterization of Power Amplifiers Using Undersampling
- 2009
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Ingår i: 2009 IEEE MTT-S International Microwave Symposium Digest. - Boston : IEEE MTT. - 9781424428038 ; , s. 1365-1368
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Konferensbidrag (refereegranskat)abstract
- In this paper a radio frequency power amplifier is measured and characterized by the use of undersampling based on the generalized Zhu-Frank sampling theorem. A test system has been designed allowing the bandwidth of the stimuli signal to be 100 MHz in the characterization process. That would not be possible with any vector signal analyzer on the market. One of the more challenging problem within the proposed concept is the model validation process. Here, two different techniques for model validation are proposed, the multitone and the spectrum scan validation methods.
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| 8. |
- Marchildon, Gregory P., et al.
(författare)
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Achieving higher performing primary care through patient registration : A review of twelve high-income countries
- 2021
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Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 125:12, s. 1507-1516
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Forskningsöversikt (refereegranskat)abstract
- Background: Patient registration with a primary care providers supports continuity in the patient provider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts.Methods: 12 jurisdictions (Denmark, France, Germany, Ireland, Israel, Italy, Netherlands, Norway, Ontario [Canada], Sweden, Switzerland, United Kingdom) were selected for analysis. Information was collected by national researchers who reviewed relevant literature and policy documents to report on the establishment and evolution of patient registration, the requirements and benefits for patients, providers and payers, and its connection to primary care reforms.Results: Patient registration emerged as part of major macro-level health reforms linked to the introduction of universal health coverage. Recent reforms introduced registration with the aim of improving quality through better coordination and efficiency through reductions in unnecessary referrals. Patient registration is mandatory only in three countries. Several countries achieve high levels of registration by using strong incentives for patients and physicians (capitation payments).Conclusion: Patient registration means different things in different countries and policy-makers and researchers need to take into consideration: the history and characteristics of the registration system; the use of incentives for patients and providers; and the potential for more explicit use of patient-provider agreements as a policy to achieve more timely, appropriate, continuous and integrated care.
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| 10. |
- Vengberg, Sofie, et al.
(författare)
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Measuring competition in primary care : Evidence from Sweden
- 2024
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 19:7
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionIn many tax-based healthcare systems, policymakers have introduced reforms that promote provider competition with the intention of improving the quality and efficiency. Healthcare competition is usually defined spatially, with local markets often being identified as a circle around each provider. We argue that existing local market definitions can be improved to better capture actual local markets. For pro-competition reforms to potentially lead to the gains envisioned by policymakers, a crucial condition is the actual emergence of competitive markets. However, limited research has been conducted on competition in primary care markets, despite primary care constituting a vital part of a healthcare system.AimThe study aims to contribute to the debate on how to define local markets geographically and to examine provider competition in Swedish primary care.MethodsA cross-sectional study was conducted using data on all individuals and all primary care providers in Sweden. Local markets were defined as: fixed radius (1 km and 3 km); variable radius; and variable shape—our new local market definition that allows markets to vary in both size and shape. Competition was measured using the Herfindahl-Hirschman index and a count of the number of competitors within the local market.ResultsFixed radius markets fail to capture variation within and across geographical areas. The variable radius and variable shape markets are similar but do not always identify the same competitors or level of competition. Furthermore, competition levels vary significantly in Swedish primary care. Many providers operate in monopoly markets, whereas others face high competition.ConclusionsWhile the variable shape approach has the potential to better capture actual markets and more accurately identify competitors, further analyses are needed. Moreover, Swedish policymakers are advised to decide whether to still pursue competition and if so, take measures to improve local market conditions in monopolies.
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