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Effects of Increased Competition on Quality of Primary Care in Sweden

Dietrichson, Jens; Ellegård, Lina Maria LU and Kjellsson, Gustav (2016) In Working Papers 2016(36).
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... (More)
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. (Less)
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author
organization
publishing date
type
Working Paper
publication status
published
subject
keywords
competition, patient choice, primary health care, quality, D04, H75, I11, I18
in
Working Papers
volume
2016
issue
36
pages
45 pages
publisher
Department of Economics, Lund University
language
English
LU publication?
yes
id
2f04dc51-a3ba-4774-a65d-392bc2f60e9c
alternative location
http://swopec.hhs.se/lunewp/abs/lunewp2016_036.htm
date added to LUP
2016-12-28 11:24:22
date last changed
2016-12-28 11:24:22
@misc{2f04dc51-a3ba-4774-a65d-392bc2f60e9c,
  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.},
  author       = {Dietrichson, Jens and Ellegård, Lina Maria and Kjellsson, Gustav},
  keyword      = {competition,patient choice,primary health care,quality,D04,H75,I11,I18},
  language     = {eng},
  month        = {12},
  note         = {Working Paper},
  number       = {36},
  pages        = {45},
  publisher    = {Department of Economics, Lund University },
  series       = {Working Papers},
  title        = {Effects of Increased Competition on Quality of Primary Care in Sweden},
  volume       = {2016},
  year         = {2016},
}