ArticleBMC health services research2018
Does risk-adjusted payment influence primary care providers' decision on where to set up practices?
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed.
- From Integrated Care to Learning Systems.Healthcare (Basel, Switzerland) · 2026Review
- Can the Care Need Index Identify Healthcare Centres With Higher Proportions of Children at Risk?Acta paediatrica (Oslo, Norway : 1992) · 2026Article
- Evaluating the impact of capitation funding top-up payments in primary care.BMC primary care · 2026Observational
- Do Physicians Respond to Additional Capitation Payments in Mixed Remuneration Schemes?Health economics · 2025Article
- Risk Adjustment in Capitation Payments to Primary Care Providers: Does It Matter How We Account for Patients' Socioeconomic Status?Medical care · 2025Article
- Health Reform in Aotearoa New Zealand: Insights on Health Equity Challenges One Year On.Applied health economics and health policy · 2023Article
- Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?Scandinavian journal of public health · 2022Review
- New reimbursement model in Icelandic primary care in 2017: first-year comparison of public and private primary care.Scandinavian journal of primary health care · 2022Article
- Weak association between socioeconomic Care Need Index and primary care visits per registered patient in three Swedish regions.Scandinavian journal of primary health care · 2021Observational
- Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care.BMC family practice · 2021Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundProviding equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where private providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county councils in Sweden have implemented risk-adjusted capitation based on the Care Need Index, which increases capitation to primary care centers with a large share of patients with unfavorable socioeconomic and demographic characteristics. Our aim is to estimate the effects of using care-need adjusted capitation on the supply of private primary care centers.
methodWe use a dataset that combines information on all primary care centers in Sweden during 2005-2013, the payment system and other conditions for establishing new primary care centers used in the county councils, and demographic, geographic, and socioeconomic variables for low-level geographic areas. To estimate the effects of care-need adjusted capitation, we use difference-in-differences models, contrasting the development over time between areas with and without risk-adjusted capitation, and with high and low Care Need Index values.
resultsRisk-adjusted capitation significantly increases the number of private primary care centers in areas with relatively high Care Need Index values. The adjustment results in a changed distribution of private centers within county councils; the total number of private centers does not increase in county councils using care-need adjusted capitation. The effects are furthermore increasing over the first three years after the implementation of such capitation, and concentrated to the lower and middle range of the group of areas with high index values.
conclusionsRisk-adjusted capitation based on the Care Need Index increases the supply of private primary care centers in areas with unfavorable socioeconomic and demographic characteristics. More generally, this result indicates that risk-adjusted capitation can significantly affect private providers' establishment decisions.
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Registered trials
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