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Better off by risk adjustment? Socioeconomic disparities in care utilization in Sweden following a payment reform

Anell, Anders LU ; Dackehag, Margareta LU orcid ; Dietrichson, Jens ; Ellegård, Lina Maria LU and Kjellsson, Gustav (2024) In Journal of Policy Analysis and Management
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... (More)
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. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of Policy Analysis and Management
publisher
Wiley-Blackwell
external identifiers
  • scopus:85192478018
ISSN
0276-8739
DOI
10.1002/pam.22610
language
English
LU publication?
yes
id
2f4bce3d-8e11-4f50-b49a-8249e5ed1d5b
date added to LUP
2024-06-03 21:30:25
date last changed
2024-06-04 08:58:16
@article{2f4bce3d-8e11-4f50-b49a-8249e5ed1d5b,
  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.}},
  author       = {{Anell, Anders and Dackehag, Margareta and Dietrichson, Jens and Ellegård, Lina Maria and Kjellsson, Gustav}},
  issn         = {{0276-8739}},
  language     = {{eng}},
  month        = {{05}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Policy Analysis and Management}},
  title        = {{Better off by risk adjustment? Socioeconomic disparities in care utilization in Sweden following a payment reform}},
  url          = {{http://dx.doi.org/10.1002/pam.22610}},
  doi          = {{10.1002/pam.22610}},
  year         = {{2024}},
}