Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Department of Governance, Uppsala University, Uppsala, Sweden.
BMJ Open. 2018 Oct 23;8(10):e020402. doi: 10.1136/bmjopen-2017-020402.
To assess socioeconomic differences between patients registered with private and public primary healthcare centres.
Population-based cross-sectional study controlling for municipality and household.
Swedish population-based socioeconomic data collected from Statistics Sweden linked with individual registration data from all 21 Swedish regions.
All individuals residing in Sweden on 31 December 2015 (n=9 851 017) were included in the study.
Registration with private versus public primary healthcare centres.
After controlling for municipality and household, individuals with higher socioeconomic status were more likely to be registered with a private primary healthcare provider. Individuals in the highest income quantile were 4.9 percentage points (13.7%) more likely to be registered with a private primary healthcare provider compared with individuals in the lowest income quantile. Individuals with 1-3 years of higher education were 4.7 percentage points more likely to be registered with a private primary healthcare provider compared with those with an incomplete primary education.
The results show that there are notable differences in registration patterns, indicating a skewed distribution of patients and health risks between private and public primary healthcare providers. This suggests that risk selection behaviour occurs in the reformed Swedish primary healthcare system, foremost through location patterns.
评估在私人和公共初级保健中心注册的患者之间的社会经济差异。
基于人群的横断面研究，控制了市和家庭因素。
从瑞典统计局收集的基于人群的社会经济数据，与来自瑞典所有 21 个地区的个人登记数据相关联。
所有于 2015 年 12 月 31 日居住在瑞典的人（n=9 851 017）均纳入研究。
在私人和公共初级保健中心的注册情况。
在控制了市和家庭因素后，社会经济地位较高的个体更有可能在私人初级保健提供者处注册。与收入最低的个体相比，收入最高的个体在私人初级保健提供者处注册的可能性高 4.9 个百分点（13.7%）。接受 1-3 年高等教育的个体在私人初级保健提供者处注册的可能性比未完成小学教育的个体高 4.7 个百分点。
结果表明，注册模式存在显著差异，表明私人和公共初级保健提供者之间的患者和健康风险分布存在偏差。这表明，风险选择行为发生在改革后的瑞典初级保健系统中，主要通过位置模式。
