title: Impact of comorbidity on the individual's choice of primary health care provider.
abstract: OBJECTIVE. This study examined whether age, gender, and comorbidity were of importance for an individual's choice of listing with either a public or a private primary health care (PHC) practice. DESIGN AND SETTING. The study was a register-based closed cohort study in one private and one public PHC practice in Blekinge County in southern Sweden. Subjects. A cohort (12 696 individuals) was studied comprising all those listed with the public or private PHC practice on 1 October 2005 who were also listed with the public PHC practice on 1 October 2004. MAIN OUTCOME MEASURES. The listing/re-listing behaviour of the population in this cohort was studied at two points in time, 1 October 2005 and 1 October 2006, with respect to age, gender, and comorbidity level as measured by the ACG Case-Mix system. RESULTS. Individuals listed with the public practice both on 1 October 2005 and one year later were significantly older, were more often females, and had a higher comorbidity level than individuals listed with the private practice. Individuals with a higher comorbidity level were more likely to re-list or to stay listed with the public practice. CONCLUSIONS. This study shows that the probability of choosing a public instead of private PHC provider increased with higher age and comorbidity level of the individuals. It is suggested that using a measure of comorbidity can help us understand more about the chronically ill individual's choice of health care provider. This would be of importance when health care policy-makers decide on reimbursement system or organization of PHC.
authors.affiliation: Lund University, Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Sweden. andrzej.zielinski@med.lu.se
authors.forename: Andrzej
authors.initials: A
authors.lastname: Zielinski
authors.forename: Anders
authors.initials: A
authors.lastname: Håkansson
authors.forename: Anders
authors.initials: A
authors.lastname: Beckman
authors.forename: Anders
authors.initials: A
authors.lastname: Halling
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002755:Choice Behavior; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003953:Diagnosis-Related Groups; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011320:Primary Health Care; D017149:Private Sector; D017150:Public Sector; D012737:Sex Factors; D013548:Sweden