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Patient Choice, Entry, and the Quality of Primary Care: Evidence from Swedish Reforms

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Abstract

Policies aimed to spur quality competition among health care providers are ubiquitous, but their impact on quality is ex ante ambiguous. This study contributes to the sparse empirical literature on primary care quality by examining the heterogeneous impact of recent competition enhancing reforms in Sweden. The reforms led to substantially more entry of new providers in more exposed markets, but the effects on primary care quality in these markets were modest: we find small improvements of patients’ overall satisfaction with care, but no consistently significant effects on avoidable hospitalization rates or satisfaction with access to care.

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  • Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2016. "Patient Choice, Entry, and the Quality of Primary Care: Evidence from Swedish Reforms," Working Papers 2016:36, Lund University, Department of Economics, revised 27 Jun 2018.
    • Handle: RePEc:hhs:lunewp:2016_036
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    2. Gravelle, Hugh & Liu, Dan & Propper, Carol & Santos, Rita, 2019. "Spatial competition and quality: Evidence from the English family doctor market," Journal of Health Economics, Elsevier, vol. 68(C).
    3. Anell, Anders & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2021. "Information, switching costs, and consumer choice: Evidence from two randomised field experiments in Swedish primary health care," Journal of Public Economics, Elsevier, vol. 196(C).
    4. Ge Ge & Tor Iversen & Oddvar Kaarbøe & Øyvind Snilsberg, 2024. "Impacts of Norway's extended free choice reform on waiting times and hospital visits," Health Economics, John Wiley & Sons, Ltd., vol. 33(4), pages 779-803, April.
    5. Anell, Anders & Dackehag, Margareta & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2022. "Better Off by Risk Adjustment? Socioeconomic Disparities in Care Utilization in Sweden Following a Payment Reform," Working Papers 2022:15, Lund University, Department of Economics, revised 12 Mar 2024.
    6. Lina Maria Ellegård, 2020. "Effects of pay-for-performance on prescription of hypertension drugs among public and private primary care providers in Sweden," International Journal of Health Economics and Management, Springer, vol. 20(3), pages 215-228, September.
    7. Elina Jussila & Kaisa Kotakorpi & Jouko Verho, 2022. "Prescription behavior of physicians in the public and private sector," Working Papers 5, Finnish Centre of Excellence in Tax Systems Research.
    8. Andersson, Tommy & Ellegård, Lina Maria & Enache, Andreea & Erlanson, Albin & Thami, Prakriti, 2021. "Multiple Pricing for Personal Assistance Services," Working Papers 2021:14, Lund University, Department of Economics, revised 25 Oct 2023.
    9. Anthony Scott & Peter Sivey, 2022. "Motivation and competition in health care," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1695-1712, August.
    10. Visa Pitkänen, 2022. "Competition and efficiency in repeated procurements: Lessons from the Finnish rehabilitation markets," Health Economics, John Wiley & Sons, Ltd., vol. 31(5), pages 820-835, May.
    11. Godager , Geir & Scott, Anthony, 2023. "Physician Behavior and Health Outcomes," HERO Online Working Paper Series 2023:3, University of Oslo, Health Economics Research Programme.
    12. Dahlgren, Cecilia & Dackehag, Margareta & Wändell, Per & Rehnberg, Clas, 2021. "Simply the best? The impact of quality on choice of primary healthcare provider in Sweden," Health Policy, Elsevier, vol. 125(11), pages 1448-1454.

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    More about this item

    Keywords

    Competition; Patient choice; Primary health care; Quality;
    All these keywords.

    JEL classification:

    • D04 - Microeconomics - - General - - - Microeconomic Policy: Formulation; Implementation; Evaluation
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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