Impact of increased patient choice of providers in Sweden: cataract surgery.
OBJECTIVE
Choice of provider was introduced in Sweden in 2001. Our aim was to describe the scope and character of patient flows and to analyze any differences between patients who chose to move outside of their home county (movers) and those who did not (non-movers) with regard to age, sex, waiting time and level of need.


METHODS
Use of cataract operations between 2005 and 2008 based on data from the National Cataract Register. Data were analysed using descriptive statistics, odds ratios and multivariate regression analysis to compare movers and non-movers. Information on contracting between county councils and providers in other counties was obtained from a survey.


RESULTS
Only 4% of cataract patients were treated by a provider outside their home county. Patient flows were mainly determined by contracts between county councils and providers, and only 1% were considered to be 'true' movers (i.e. patients who were not part of any special contracting agreement). Movers differed from non-movers in that they were on average younger, had less serious visual problems and had shorter waiting times.


CONCLUSIONS
Though patient flows are minor in scope, the possibility of changing provider has probably been important in tackling long waits in some counties. However, the reform may threaten the equity of health care use.
Department of Public Health and Caring Sciences, University Hospital Uppsala, Sweden. marianne.hanning@socialstyrelsen.se
Marianne
M
Hanning
Annika
A
Åhs
Ulrika
U
Winblad
Mats
M
Lundström
D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data*; D012042:Registries; D013222:State Medicine / Q000458:organization & administration*; D013548:Sweden; D013997:Time Factors; D014850:Waiting Lists