ArticleBMC health services research2023
Trajectories of primary health care utilization: a 10-year follow-up after the Swedish Patient Choice Reform of primary health care.
Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Continuity of care in the context of a primary health care reform: a follow-up after the SwedishScandinavian journal of primary health care · 2026Article
- Variations in geographical accessibility: a cross-sectional nationwide study of travel times in Swedish primary care.BMJ open · 2026Article
- Access to choice‑enabled healthcare providers among children and adults with intellectual disabilities in comparison with the general population (IDcare).BMC health services research · 2026Article
- Use of general practitioner services among high-cost older patients in somatic hospitals - a Norwegian registry-based study.BMC health services research · 2026Observational
- Coordinated Care: the new model in primary health care in Poland-Implementation and early trends.Frontiers in public health · 2026Review
- Rate and Characteristics of Frequent Attenders at Primary Healthcare Centres in Muscat Governorate, Oman:Sultan Qaboos University medical journal · 2026Article
- Long-term trends in specialized outpatient health care utilization: an analysis in the context of a primary health care reform.BMC health services research · 2025Article
- Utilization of Municipal Healthcare Services Among High-Cost Older Patients in Norwegian Somatic Hospitals: A Cross-Sectional Registry Study.Health services insights · 2025Article
- Evaluating the impact of the 2010 Swedish choice reform in primary health care on avoidable hospitalization and socioeconomic inequities: an interrupted time series analysis using register data.BMC health services research · 2024Article
- Universal health coverage and equal access in Sweden: a century-long perspective on macro-level policy.International journal for equity in health · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn January 2010, the choice reform was instituted in Swedish primary health care establishing free entry for private primary health care providers and enabling patients to choose freely among primary health care centers. The motivation behind the reform was to improve access to primary care and responsiveness to patient expectations. Reform effects on health care utilization have previously been investigated by using subgroup analyses assuming a pattern of homogeneous subgroups of the population. By using a different methodological approach, the aim of this study was to, from an equity perspective, investigate long term trends of primary health care utilization following the choice reform.
methodA closed cohort was created based on register data from Region Skåne, the third most populated region in Sweden, describing individuals' health care utilization between 2007-2017. Using a novel approach, utilization data, measured as primary health care visits, was matched with socioeconomic and geographic determinants, and analyzed using logistic regression models.
resultsA total of 659,298 individuals were included in the cohort. Sex differences in utilization were recorded to decrease in the older age group and to increase in the younger age group. Multivariable logistic regression showed increasing utilization in older men to be associated with higher socioeconomic position, while in women it was associated with lower socioeconomic position. Furthermore, groups of becoming high utilizers were all associated with lower socioeconomic position and with residence in urban areas.
conclusionThe impact of demographic, socioeconomic and geographic determinants on primary health care utilization varies in magnitude and direction between groups of the population. As a result, the increase in utilization as observed in the general population following the choice reform is unevenly distributed between different population groups.
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