Anell Anders, Dackehag Margareta, Ellegård Lina Maria
Department of Business Administration, Lund University, Lund, Sweden.
Department of Economics, Lund University, Lund, Sweden.
Scand J Prim Health Care. 2021 Sep;39(3):288-295. doi: 10.1080/02813432.2021.1928836. Epub 2021 Jun 7.
The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status.
Observational study combining graphical analysis with linear regressions of cross-sectional administrative practice-level data.
Three Swedish regions, Västra Götaland, Skåne and Östergötland (3.5 million residents). Outcomes were measured in February 2018 and the CNI was computed based on data for 31 December 2017.
The unit of analysis was the primary care practice ( = 390).
i) Number of GP visits per registered patient; ii) Number of nurse visits per registered patient; iii) Number of morbidity-weighted GP visits per registered patient; iv) Number of morbidity-weighted nurse visits per registered patient.
The linear associations between the CNI and GP visits per patient were positive and statistically significant (p<0.01) for both the unweighted and weighted measure in two regions, but the associations were mainly due to 10 practices with very high CNI values. The results for nurse visits varied across regions.
For most levels of the CNI, there was no association with the number of consultations provided. This result may indicate insufficient compensation, weak incentives to spend the money, decisions to spend the money on other things than consultations, or stronger competition for patients among low-CNI practices. The result of this observational study should not be taken as evidence against the possibility that the CNI adjustment of capitation may have affected the socioeconomic equity in GP and nurse visits.Key PointsSwedish primary care practices receive extra compensation for socioeconomically deprived patients but it is unknown how this affects service provision.Practice-level data from three regions years 2017-2018 indicate weak or no relation between the socioeconomic burden and the number of physical consultations per patient.Results are similar when adjusting for patients' morbidity levels, suggesting that the weak gradient was not explained by longer consultations.The exception is that a small number of practices with very high burdens provide more consultations per patient.The results may reflect insufficient compensation, lack of incentives, or funds being spent on other things than consultations.
本研究旨在探讨初级保健会诊与护理需求指数（CNI）之间的关联，该指数用于补偿瑞典初级保健机构因社会经济地位较低患者带来的额外工作量。
观察性研究，结合图形分析与横断面行政实践水平数据的线性回归。
瑞典的三个地区，西约塔兰、斯科讷和东约特兰（350万居民）。结局指标于2018年2月测量，CNI基于2017年12月31日的数据计算得出。
分析单位为初级保健机构（n = 390）。
i）每位注册患者的全科医生就诊次数；ii）每位注册患者的护士就诊次数；iii）每位注册患者的发病率加权全科医生就诊次数；iv）每位注册患者的发病率加权护士就诊次数。
在两个地区，无论是未加权还是加权测量，CNI与每位患者的全科医生就诊次数之间的线性关联均为正且具有统计学意义（p<0.01），但这种关联主要归因于10个CNI值非常高的机构。护士就诊的结果因地区而异。
对于大多数CNI水平，其与提供的会诊次数无关。这一结果可能表明补偿不足、花钱的激励措施薄弱、将资金用于会诊以外的其他事情的决策，或者低CNI机构之间对患者的竞争更激烈。本观察性研究的结果不应被视为反对按人头计算的CNI调整可能影响全科医生和护士就诊的社会经济公平性的证据。要点瑞典初级保健机构会因社会经济贫困患者获得额外补偿，但尚不清楚这如何影响服务提供。2017 - 2018年三个地区的实践水平数据表明，社会经济负担与每位患者的实际会诊次数之间关系微弱或无关联。调整患者发病率水平后结果相似，表明微弱的梯度并非由更长的会诊时间所解释。例外情况是少数负担非常高的机构每位患者提供更多会诊。结果可能反映出补偿不足、缺乏激励措施或资金用于会诊以外的其他事情。
