Department of Business Administration, Lund University School of Economics and Management, Box 7080, SE-220 07 Lund, Sweden.
Health Econ Policy Law. 2023 Jul;18(3):219-233. doi: 10.1017/S1744133122000251. Epub 2022 Nov 9.
This study contributes to the sparse literature on differences between public and private primary care practices (PCCs). The purpose was to explore if differences in performance and characteristics between public and PCCs persist over time in a welfare market with patient choice and provider competition, where public and private providers operate under similar conditions. The analysis is based on data from a national patient survey and administrative registries in a large Swedish region, covering PCC observations in 2010 and 2019, i.e., the year after and 10 years after introducing choice and competition in the region. The findings suggest that differences across owner types tend to decrease over time in welfare markets. Differences in patients' experiences, PCC size, patient mix and the division of labour have decreased or disappeared between 2010 and 2019. There were small but significant differences in process measures of quality in 2019; public PCCs complied better with prescription guidelines. While the results demonstrate a convergence between public and private PCCs in regards to their characteristics and performance, differences in patients' experiences in regards to socioeconomic conditions persisted. Such unwarranted variation calls for continued attention from policy makers and further research about causes.
本研究有助于填补公共和私营初级保健实践（PCC）之间差异的文献空白。目的是探讨在具有患者选择和提供者竞争的福利市场中，公共和 PCC 的绩效和特征是否会随着时间的推移而持续存在，在这个市场中，公共和私人提供者在相似的条件下运作。该分析基于来自瑞典一个大型地区的全国性患者调查和行政登记处的数据，涵盖了 2010 年和 2019 年的 PCC 观察结果，即该地区引入选择和竞争的次年和 10 年后。研究结果表明，在福利市场中，不同所有者类型之间的差异往往会随着时间的推移而减少。在 2010 年至 2019 年间，患者体验、PCC 规模、患者构成和劳动分工方面的差异已经缩小或消失。在 2019 年，质量过程指标方面存在较小但显著的差异；公共 PCC 更符合处方指南。虽然这些结果表明公共和私营 PCC 在特征和绩效方面趋同，但在患者对社会经济条件的体验方面仍存在差异。这种不必要的差异需要政策制定者继续关注，并进一步研究其原因。
