title: Is the quality of primary healthcare services influenced by the healthcare centre's type of ownership?-An observational study of patient perceived quality, prescription rates and follow-up routines in privately and publicly owned primary care centres.
abstract: BACKGROUND
  Primary healthcare in Sweden has undergone comprehensive reforms, including freedom of choice regarding provider, freedom of establishment and increased privatisation aiming to meet demands for quality and availability. In this system privately and publicly owned primary care centres with different business models (for-profit vs non-profit) coexist and compete for patients, which makes it important to study whether or not the type of ownership influences the quality of the primary healthcare services.
  
  
  METHODS
  In this retrospective observational study (April 2011 to January 2014) the patient perceived quality, the use of antibiotics and benzodiazepine derivatives, and the follow-up routines of certain chronic diseases were analysed for all primary care centres in Region Västra Götaland. The outcome measures were compared on a group level between privately owned (n = 86) and publicly owned (n = 114) primary care centres (PCC).
  
  
  RESULTS
  In comparison with the group of publicly owned PCCs, the group of privately owned PCCs were characterized by: a smaller, but continuously growing share of the population served (from 32 to 36%); smaller PCC population sizes (avg. 5932 vs. 9432 individuals); a higher fraction of PCCs located in urban areas (57% vs 35%); a higher fraction of listed citizens in working age (62% vs. 56%) and belonging to the second most affluent socioeconomic quintile (26% vs. 14%); higher perceived patient quality (82.4 vs. 79.6 points); higher use of antibiotics (6.0 vs. 5.1 prescriptions per 100 individuals in a quarter); lower use of benzodiazepines (DDD per 100 patients/month) for 20-74 year olds (278 vs. 306) and >74 year olds (1744 vs.1791); lower rates for follow-ups of chronic diseases (71.2% vs 74.6%). While antibiotic use decreased, the use of benzodiazepines increased for both groups over time.
  
  
  CONCLUSIONS
  The findings of this study cannot unambiguously answer the question of whether or not the quality is influenced by the healthcare centre's type of ownership. It can be questioned whether the reform created conditions that encouraged quality improvements. Tendencies of an (unintended) unequal distribution of the population between the two groups with disparities in age, socio-economy and geography might lead to unpredictable effects. Further studies are necessary for evidence-informed policy-making.
authors.affiliation: Department of Medicine, Division of General Practice, University Medical Centre Freiburg, Elsässerstr. 2 m, D-79110, Freiburg, Germany. andy.maun@gu.se.|Institute for Quality Management and Social Medicine, University Medical Centre Freiburg, Engelbergerstr. 21, D-79106, Freiburg, Germany. andy.maun@gu.se.|Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, SE-405 30, Göteborg, Sweden. andy.maun@gu.se.
authors.forename: Andy
authors.initials: A
authors.lastname: Maun
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, SE-405 30, Göteborg, Sweden. catrin.wessman@gu.se.|Centre for Applied Biostatistics, The Sahlgrenska Academy, University of Gothenburg, Box 414, SE-405 30, Göteborg, Sweden. catrin.wessman@gu.se.
authors.forename: Catrin
authors.initials: C
authors.lastname: Wessman
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, SE-405 30, Göteborg, Sweden. par-daniel.sundvall@vgregion.se.|Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden. par-daniel.sundvall@vgregion.se.
authors.forename: Pär-Daniel
authors.initials: PD
authors.lastname: Sundvall
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, SE-405 30, Göteborg, Sweden. jorgen.thorn@allmed.gu.se.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Thorn
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, SE-405 30, Göteborg, Sweden. cecilia.bjorkelund@allmed.gu.se.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Björkelund
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006269:Health Facilities, Proprietary; D006292:Health Priorities / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation / Q000191:economics; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D011332:Privatization / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology