title: Patient choice, Internet based information sources, and perceptions of health care: Evidence from Sweden using survey data from 2010 and 2013.
abstract: Several countries have increased patients' abilities to choose their health care providers, frequently under the assumption that patients are themselves the best agents to make such decisions. In parallel, national and regional health authorities have enhanced access to Internet based information sources (IBIS) to assist patients in making an informed choice. Relatively little, however, is known about the effect that the use of such sources has on key outcomes, including patients' perceptions of care. The aim of this study is to analyze the role of the Internet for patients' confidence in the provider and perceived access to care in the context of choice based reforms in Sweden.
  
  
  
  The study uses a regional, population health survey from the southern part of Sweden. Non-parametric chi-square tests are used to assess the nature of Internet users, including their gender, age and socioeconomic status. Logistic regression models are specified to analyze the role of IBIS on patient perceptions of care while controlling for other factors.
  
  
  
  Actual use of Internet based information sources for health care was relatively low in 2010 and only somewhat higher in 2013. The characteristics of IBIS users varied significantly across different population groups, such that they were younger, more educated, female, and also considered themselves to be in better health compared with those who reported not using this source of health care information. Finally, the average IBIS user was less likely to report having a high level of satisfaction with respect to their primary care use; OR 0.69 [95 % CI: 0.54-0,87] and OR 0.52 [95 % CI: 0,41-0,66], for confidence in provider and perceived access to care, respectively, in 2013.
  
  
  
  Despite health agencies' attempts to make information on health care providers available on the Internet, this source of health care information is not used to any large extent in the current sample. The fact that some people use this source of information more compared with others suggests the need to consider alternative ways of informing the general public about choice options. The use of Internet based sources may also be linked with the experience of actually using health services, which suggests a need to further analyze this complex consumer behavior process.
authors.affiliation: Social Medicine and Global Health (SMGH), Lund University, Lund, Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Wahlstedt
authors.affiliation: Social Medicine and Global Health (SMGH), Lund University, Lund, Sweden. bjorn.ekman@med.lu.se.
authors.forename: Björn
authors.initials: B
authors.lastname: Ekman
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D054626:Consumer Health Information / Q000592:standards / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D012923:Social Class; D013548:Sweden
keywords: Access to care; Health care reform; Internet; Patient choice; Patient satisfaction; Sweden