Practice variation in Swedish primary care.
OBJECTIVE
To study individual practice patterns of physicians working in primary health care for standardized simulated cases on their first visit, and relate them to resource consumption for diagnostic tests, drugs and sick leave from a combined perspective of the health care and social security systems.


METHODS
Postal questionnaire presenting six hypothetical working-age cases with symptoms of ailments common in primary care asking physicians to order diagnostic tests and procedures, drugs, follow-up appointments and sick pay.


METHODS
Swedish primary health care centres.


METHODS
Two hundred randomly selected physicians.


METHODS
Activities taken by the physician-diagnostic and laboratory tests ordered, drugs prescribed, length of sick leave and the cost of these actions.


RESULTS
Practice patterns varied considerably, corresponding to a six-fold difference in total cost between the "cheapest" and "most expensive" physician. The largest share was loss of production as estimated by the cost of prescribed sick leave. Physicians who practised further away from hospitals and those who had worked more years tended to prescribe more measures. However, this only explained a small portion of the observed variation, which may be due to different physician attitudes to taking risks.


CONCLUSIONS
"Paper" cases of common medical ailments presented to primary care physicians revealed considerable differences in practice style, resulting in six-fold differences in cost of measures prescribed at first visits.
Peterson
S
S
Department of Family Medicine, Uppsala University, Sweden.
Eriksson
M
M
Tibblin
G
G
D000328:Adult; D003955:Diagnostic Tests, Routine; D005194:Family Practice; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics*; D013548:Sweden