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Choice and privatisation in Swedish primary care

Published online by Cambridge University Press:  12 August 2010

Anders Anell
Anders Anell*
Affiliation:
Institute of Economic Research and Department of Business Administration, Lund University School of Economics and Management, Lund, Sweden
*
*Correspondence to: Anders Anell, Institute of Economic Research, Lund University School of Economics and Management, P.O. Box 7080, Lund SE-220 07, Sweden. Email: anders.anell@fek.lu.se
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Abstract

In 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended.

Type
Articles
Information
Health Economics, Policy and Law , Volume 6 , Issue 4 , 06 September 2011 , pp. 549 - 569
Copyright
Copyright © Cambridge University Press 2010

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