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Weak association between socioeconomic Care Need Index and primary care visits per registered patient in three Swedish regions

Anell, Anders LU ; Dackehag, Margareta LU and Ellegård, Lina Maria LU (2021) In Scandinavian Journal of Primary Health Care 39(3). p.288-295
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... (More)

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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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Family practice, health economy, health services research, quality development, statistics, Care Need Index, risk-adjusted payment
in
Scandinavian Journal of Primary Health Care
volume
39
issue
3
pages
288 - 295
publisher
Taylor & Francis
external identifiers
  • scopus:85107479639
  • pmid:34096820
ISSN
0281-3432
DOI
10.1080/02813432.2021.1928836
project
Public Management Research
language
English
LU publication?
yes
id
2bf25821-6ef0-40ed-8d9a-b5d357ae3893
date added to LUP
2021-06-14 09:20:26
date last changed
2024-04-06 05:04:35
@article{2bf25821-6ef0-40ed-8d9a-b5d357ae3893,
  abstract     = {{<p>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.</p><p>DESIGN: Observational study combining graphical analysis with linear regressions of cross-sectional administrative practice-level data.</p><p>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.</p><p>SUBJECTS: The unit of analysis was the primary care practice (n = 390).</p><p>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.</p><p>RESULTS: The linear associations between the CNI and GP visits per patient were positive and statistically significant (p&lt;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.</p><p>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.</p>}},
  author       = {{Anell, Anders and Dackehag, Margareta and Ellegård, Lina Maria}},
  issn         = {{0281-3432}},
  keywords     = {{Family practice; health economy; health services research; quality development; statistics; Care Need Index; risk-adjusted payment}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{3}},
  pages        = {{288--295}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Primary Health Care}},
  title        = {{Weak association between socioeconomic Care Need Index and primary care visits per registered patient in three Swedish regions}},
  url          = {{http://dx.doi.org/10.1080/02813432.2021.1928836}},
  doi          = {{10.1080/02813432.2021.1928836}},
  volume       = {{39}},
  year         = {{2021}},
}