Programme no. 541-OP
Quality Improvement
Is the quality of primary healthcare services influenced by the healthcare centre’s type of ownership? - An observational study of privately and publicly owned primary care centres in Sweden.
Andy Maun*1, Pär-Daniel Sundvall2, Jörgen Thorn3, Catrin Wessman4, Cecilia Björkelund5
1Department of Public Health and Community Medicine/Primary Health Care,Sahlgrenska Academy at the University of Gothenburg,Gothenburg,Sweden, 2Department of Public Health and Community Medicine/Primary Health Care,Sahlgrenska Academy at the University of Gothenburg,Gothenburg,Sweden, 3Department of Public Health and Community Medicine/Primary Health Care,Sahlgrenska Academy at the University of Gothenburg,Gothenburg,Sweden, 4Centre for Applied Biostatistics,The Sahlgrenska Academy, University of Gothenburg,Gothenburg,Sweden, 5Department of Public Health and Community Medicine/Primary Health Care,Sahlgrenska Academy at the University of Gothenburg,Gothenburg,Sweden
* = Presenting author
Objectives: This study aims to investigate whether or not the type of ownership influences the quality of the primary healthcare services provided.
Background:

Primary healthcare in Sweden has undergone comprehensive reforms, including freedom of choice regarding provider, freedom of establishment and increased privatisation in order to meet demands for quality and availability. While the publicly owned primary care centres (PCCs) belong to non-profit organisations, privately owned PCCs have the option of being profit-making organisations.

Results: In comparison with publicly owned PCCs, privately owned PCCs were characterized by: urban overrepresentation (54%); smaller population sizes (avg. 5932 vs. 9432 individuals); overrepresentation of individuals of working age (62% vs. 56%) and belonging to the second most affluent socioeconomic quintile (26% vs. 14%); better results in perceived patient quality (82.4 vs. 79.6 points); higher 3-month prescription rates of antibiotics per 100 individuals (6.0 vs. 5.1 prescriptions) with a larger variance (SD 2.78 vs. 1.50); lower prescription rates of benzodiazepines; lower rates for follow-ups of chronic disease. While antibiotic use decreased, the use of benzodiazepines increased on average for all PCCs over time.
Material/Methods: In this retrospective observational study the patient perceived quality, the rates of purchased prescriptions of antibiotics and benzodiazepine derivatives, and the follow-up routines of certain chronic diseases at all accessible primary care centres in Region Västra Götaland were analysed for the period between April 2011 and January 2014. The outcome measures were compared on a group level between privately owned (n=86) and publicly owned (n=114) PCCs.
Conclusion: The findings of this study cannot unambiguously answer the question of whether or not the quality of primary healthcare services is influenced by the healthcare centre’s type of ownership. The effects on the quality of the medical services in a competitive environment remain unclear and indicate that a longer observation period is needed to elucidate possible causal relations.
Points for discussion: Consequences of these findings and future research.