| 1. |
- 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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| 2. |
- 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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| 3. |
- 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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| 4. |
- 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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| 5. |
- Anell, Anders, et al.
(författare)
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Well-Informed Choices? Effects of Information Interventions in Primary Care on Care Quality
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Market frictions, such as imperfect information or hassle costs, may reduce benefits from market incentives in healthcare settings. We use data from two randomised policy interventions in a Swedish region, which improved the access to provider information and reduced the switching costs of one percent of the adult population and of a sample of new residents. We examine the effects of the interventions on a large number of clinical process quality measures, access to care, and adverse health events, measured at the individual level. We find no significant effect of the interventions on any of the quality measures.
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| 6. |
- Dietrichson, Jens, et al.
(författare)
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Effects of Increased Competition on Quality of Primary Care in Sweden
- 2016
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- In the last decades, many health systems have implemented policies to make care providers engage in quality competition. But care quality is a multi-dimensional concept, and competition may have different impacts on different dimensions of quality. The empirical evidence on competition and care quality is scarce, in particular regarding primary care. This paper adds evidence from recent reforms of Swedish primary care that affected competition in municipal markets differently depending on the pre- reform market structure. Using a difference-in-differences strategy, we demonstrate that the reforms led to substantially more entry of private care providers in municipalities where there were many patients per provider before the reforms. The effects on primary care quality in these municipalities are modest: we find small improvements in subjective measures of overall care quality, but no significant effects on the rate of avoidable hospitalizations or patients’ satisfaction with access to care. We find no indications of quality reductions.
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| 7. |
- Dietrichson, Jens, et al.
(författare)
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Patient choice, entry, and the quality of primary care: Evidence from Swedish reforms
- 2020
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Ingår i: Health Economics. - : Wiley. - 1057-9230 .- 1099-1050. ; 29:6, s. 716-730
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Tidskriftsartikel (refereegranskat)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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| 8. |
- Ellegård, Lina Maria, et al.
(författare)
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An App Call a Day Keeps the Patient Away? : Substitution of Online and In-Person Doctor Consultations Among Young Adults
- 2022
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Annan publikation (populärvet., debatt m.m.)abstract
- The emergence of markets for on-demand online physician consultations –direct-to-consumer telemedicine (DCT) – is currently transforming many healthcare settings. DCT may be a cost-effective substitute for ordinary consultations, but the convenience of seeking DCT may increase demand and costs for health insurers. To causally assess to which degree DCT consultations substitute for in-person consultations, we exploit exogenous changes in patient fees in a fuzzy difference-in-discontinuities analysis of young adults in Sweden. We estimate a degree of substitution of 45%, implying an increase in the consultation volume. Characteristics of the additional demand raise concerns related to healthcare equity, efficiency and costs.
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| 9. |
- Ellegård, Lina Maria, et al.
(författare)
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An App Call a Day Keeps the Patient Away? Substitution of Online and In-Person Doctor Consultations Among Young Adults
- 2021
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The emergence of markets for online physician consultations -- direct-to-consumers telemedicine (DCT) -- is transforming healthcare services in many nations. The convenience of DCT lowers the cost of seeking care, thus potentially increasing demand. Yet, it is not known whether patients consuming online care turn to traditional providers as well. This is one of the first studies to causally assess to which degree online physician consultations substitute for in-person consultations. We exploit the rapid emergence of a DCT market and exogenous changes in patient fees in a fuzzy difference-in-discontinuities analysis of young adults in two Swedish regions. We find evidence in support of partial substitution and an increase in total physician consultations.
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| 10. |
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