title: Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits.
abstract: BACKGROUND
  The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income.
  
  
  METHODS
  The study is based on register data years 2007-2011 from the Skåne Regional Council (population 1.2 million) regarding individual health care utilisation in the form of visits to general practitioner (GP). Health utilisation data was matched with data about individual's age, gender and family income provided by Statistics Sweden. Multilevel, logistic regression models were constructed to analyse changes in health utilisation in different subgroups and the probability of a GP-visit before and after reform.
  
  
  RESULTS
  Health care utilisation in terms of both number of individuals that had visited a GP and number of GP-visits per capita increased in all defined subgroups, but to a varying degree. Multilevel logistic regression showed that individuals of both genders aged above 64 and belonging to a family with an income above median had more advantage of the reform, OR 1.25-1.29.
  
  
  CONCLUSIONS
  Reforms involving choice and privatisation in Swedish primary health care improved access to GP-visits generally, but more so for individuals belonging to a family with income above the median.
authors.affiliation: Faculty of medicine, Lund University, IKVM Allmänmedicin, Jan Waldenströmsgata 35, Skånes universitetssjukhus, Malmö SE-205 02, Sweden. anders.beckman@med.lu.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Beckman
authors.forename: Anders
authors.initials: A
authors.lastname: Anell
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice / Q000458:organization & administration / Q000706:statistics & numerical data; D018166:Health Care Reform; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011332:Privatization; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology