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Continuity of care in the context of a primary health care reform : a follow-up after the Swedish Patient Choice Reform

Kohnke, Hannes LU orcid ; Zielinski, Andrzej LU ; Beckman, Anders LU orcid and Ohlsson, Henrik LU (2025) In Scandinavian Journal of Primary Health Care
Abstract

Background: Continuity of care (CoC) is essential for effective primary health care (PHC), yet Swedish PHC has historically exhibited low levels of continuity. The Swedish Patient Choice Reform introduced privatization and market-oriented principles into PHC, leading to increased utilization and growing inequities in service use driven by socioeconomic disparities and misalignment with health care needs. However, little is known about its impact on continuity. The aim of this study is to explore long-term effects of longitudinal CoC in PHC within the context of the Patient Choice Reform. Methods: Using register data from Region Skåne (2007–2017), we created three closed cohorts, each capturing three years of PHC utilization. Continuity... (More)

Background: Continuity of care (CoC) is essential for effective primary health care (PHC), yet Swedish PHC has historically exhibited low levels of continuity. The Swedish Patient Choice Reform introduced privatization and market-oriented principles into PHC, leading to increased utilization and growing inequities in service use driven by socioeconomic disparities and misalignment with health care needs. However, little is known about its impact on continuity. The aim of this study is to explore long-term effects of longitudinal CoC in PHC within the context of the Patient Choice Reform. Methods: Using register data from Region Skåne (2007–2017), we created three closed cohorts, each capturing three years of PHC utilization. Continuity with GPs was measured using the Continuity of Care Index (CoCI). Quantile regression assessed associations between continuity and individual characteristics, including age, sex, income, education and residence. Results: Among 322,641 individuals with 7,878,642 general practitioner (GP) visits, median CoCI declined from 0.17 (2007 cohort) to 0.13 (2015 cohort). Higher age, male sex and increased PHC utilization were linked to greater continuity in 2007, but these associations weakened by 2015. Conclusions: Continuity of care in Swedish PHC declined over time, particularly among older individuals and frequent PHC users. These findings highlight the need to address continuity deterioration in the context of the Patient Choice Reform.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Continuity of patient care, health care utilization, health policy, patient choice, primary health care, privatization, Sweden
in
Scandinavian Journal of Primary Health Care
publisher
Informa Healthcare
external identifiers
  • pmid:40626329
  • scopus:105010201307
ISSN
0281-3432
DOI
10.1080/02813432.2025.2527856
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
id
98892fb5-0eb3-4752-9678-1d74287ee08d
date added to LUP
2025-12-19 13:18:37
date last changed
2025-12-20 03:00:14
@article{98892fb5-0eb3-4752-9678-1d74287ee08d,
  abstract     = {{<p>Background: Continuity of care (CoC) is essential for effective primary health care (PHC), yet Swedish PHC has historically exhibited low levels of continuity. The Swedish Patient Choice Reform introduced privatization and market-oriented principles into PHC, leading to increased utilization and growing inequities in service use driven by socioeconomic disparities and misalignment with health care needs. However, little is known about its impact on continuity. The aim of this study is to explore long-term effects of longitudinal CoC in PHC within the context of the Patient Choice Reform. Methods: Using register data from Region Skåne (2007–2017), we created three closed cohorts, each capturing three years of PHC utilization. Continuity with GPs was measured using the Continuity of Care Index (CoCI). Quantile regression assessed associations between continuity and individual characteristics, including age, sex, income, education and residence. Results: Among 322,641 individuals with 7,878,642 general practitioner (GP) visits, median CoCI declined from 0.17 (2007 cohort) to 0.13 (2015 cohort). Higher age, male sex and increased PHC utilization were linked to greater continuity in 2007, but these associations weakened by 2015. Conclusions: Continuity of care in Swedish PHC declined over time, particularly among older individuals and frequent PHC users. These findings highlight the need to address continuity deterioration in the context of the Patient Choice Reform.</p>}},
  author       = {{Kohnke, Hannes and Zielinski, Andrzej and Beckman, Anders and Ohlsson, Henrik}},
  issn         = {{0281-3432}},
  keywords     = {{Continuity of patient care; health care utilization; health policy; patient choice; primary health care; privatization; Sweden}},
  language     = {{eng}},
  publisher    = {{Informa Healthcare}},
  series       = {{Scandinavian Journal of Primary Health Care}},
  title        = {{Continuity of care in the context of a primary health care reform : a follow-up after the Swedish Patient Choice Reform}},
  url          = {{http://dx.doi.org/10.1080/02813432.2025.2527856}},
  doi          = {{10.1080/02813432.2025.2527856}},
  year         = {{2025}},
}