Working Papers, Department of Economics, Lund University
Effects of Increased Competition on Quality of Primary Care in Sweden
(), Lina Maria Ellegård
() and Gustav Kjellsson
Abstract: In the last decades, many health systems have implemented
policies to make care providers engage in quality competition. But care
quality is a multi-dimensional concept, and competition may have different
impacts on different dimensions of quality. The empirical evidence on
competition and care quality is scarce, in particular regarding primary
care. This paper adds evidence from recent reforms of Swedish primary care
that affected competition in municipal markets differently depending on the
pre- reform market structure. Using a difference-in-differences strategy,
we demonstrate that the reforms led to substantially more entry of private
care providers in municipalities where there were many patients per
provider before the reforms. The effects on primary care quality in these
municipalities are modest: we find small improvements in subjective
measures of overall care quality, but no significant effects on the rate of
avoidable hospitalizations or patients’ satisfaction with access to care.
We find no indications of quality reductions.
Keywords: Competition; Patient choice; Primary health care; Quality; (follow links to similar papers)
JEL-Codes: D04; H75; I11; I18; (follow links to similar papers)
45 pages, December 14, 2016
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