Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Nov;50(7):852-863.
doi: 10.1177/14034948221095365. Epub 2022 May 20.

Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?

Mio Fredriksson  1 , David Isaksson  1
Affiliations
Review

Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?

Mio Fredriksson et al. Scand J Public Health. 2022 Nov.

Abstract

Background: In 2007, a reform of Swedish primary healthcare began when some regions implemented enhanced patient choice in combination with free establishment for private providers. Although heavily debated, in 2010 it became mandatory for all regions to implement this choice system.

Aim: The aim of this article was to review all published research articles related to the primary healthcare choice reform in Sweden, to investigate what has been published about the reform and summarise its first 15 years.

Methods: A scoping review was performed to cover the breadth of research on the reform. Searches were made in Scopus, Web of Science and PubMed for articles published between 2007 and 2021, resulting in 217 unique articles. In total, 52 articles were included.

Results: The articles were summarised and presented in relation to six overarching themes: arguments about the primary healthcare choice reform; governance and financial reimbursements; choice of provider and use of information; effects on equity and access; effects on quality; and differences between private and public primary healthcare centres.

Conclusions: The articles show that the reform has led to an increase in access to primary healthcare, but most studies indicate that the increase is inequitably distributed in terms of socioeconomy and geographical location. The effects on quality are unclear but several studies show that the mechanisms supposed to lead to quality improvements do not work as intended. Furthermore, from a population health perspective, it is time to discuss how such a responsibility can be reintegrated into primary healthcare and function with the choice system.

Keywords: Patient choice; any willing provider laws; choice of healthcare provider; primary care; primary healthcare; scoping review.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of the review process including database searches, number of abstracts screened and full text articles retrieved.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Vrangbaek K, Robertson R, Winblad U, et al.. Choice policies in Northern European health systems. Health Econ, Policy, Law 2012;7:47–71. 2012/01/10. DOI: 10.1017/s1744133111000302 - DOI - PubMed
    1. Magnussen JP, Vrangbæk K, Saltman RB. Nordic health care systems: recent reforms and current policy challenges. Maidenhead, UK: Open University Press, 2009.
    1. Ringard Å. Equitable access to elective hospital services: the introduction of patient choice in a decentralised healthcare system. Scand J Public Health 2012;40:10–17. DOI: 10.1177/1403494811418277 - DOI - PubMed
    1. Vrangbaek K, Østergren K. Patient empowerment and the introduction of hospital choice in Denmark and Norway. Health Econ, Policy Law 2006;1:371–394. 2006/10/13. DOI: 10.1017/S1744133106005032 - DOI - PubMed
    1. Anell A. Choice and privatisation in Swedish primary care. Health Econ, Policy Law 2011;6:549–569. DOI: 10.1017/S1744133110000216 - DOI - PubMed

LinkOut - more resources