Follow up of access, productivity and equity after the introduction of patient choice reforms in Stockholm primary care

The introduction of freedom of choice for patients and freedom of establishment for providers in primary care has transformed the traditional Swedish health care model. The Health Economics and Policy Research Group has followed the development after the introduction of patient choice in primary care in Stockholm for several years, and has investigated aspects such as the development of costs, productivity, quality of care and equity.

Aim of the project

The overall aim of the project was to study the effects of the patient choice reform in primary care in Stockholm with regard to health care utilization, productivity, patient satisfaction, market structure and the distribution of care. The project has also investigated more specific topics such as the patterns of visits and listings, establishments of new providers and competition.


The main results show that the patient choice reform has led to an improved availability and a substantial increase in the number of visits, primarily physician visits. The increase is partly explained by the fact that a larger share of the population is making at least one physician visit after the reform, and partly by an increased number of visits per person. Despite the large growth of the number of visits, the cost of primary care has only increased marginally, which means that an increased productivity has been achieved.

The productivity increased the most in the first year of the reform, and does not seem to have affected patient satisfaction, which was more or less unchanged during the years following the introduction of the reform.

The freedom of establishment has led to an increase in the total number of primary healthcare centers. All units established after the reform have been privately owned, and the public ownership has declined. The concentration of ownership at the primary healthcare market has decreased and the diversity and competition have increased. New primary healthcare centers have been established in both the city center as well as in outlying areas.

When it comes to the distribution of the health care utilization, the results show that individuals in areas with a low average income have increased their number of visits the most. However, the resource allocation to primary health care centers in these areas has decreased after the reform. For all studied subgroups of the population, health care utilization has increased without affecting any of the other groups negatively. The relative increase of physician visits is greater among the elderly in comparison to the younger while men and women have increased their healthcare utilization to a similar extent.

In 2016, Region Stockholm changed the reimbursement model for primary care. In the new model, the capitation part of the reimbursement increased while the remuneration for a physician visit was greatly reduced. The new model led to fewer physician visits, especially for the elderly and for people with chronic diseases.

Continued work

Future work will focus on the effects of the changes to the reimbursement model in primary care that have been introduced in 2016. The research group will also analyze the patient flow between different levels of care related to primary care and follow a number of pilot projects at different primary health care centers. The project will be reported in 2017.

Reports and publications

There is currently only Swedish material published. Please visit our Swedish site.

Contact person

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Cecilia Dahlgren

Affiliated to Research
Fanny Goude