Choosing health care center – preconditions for competition on quality
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Choosing health care center – preconditions for competition on quality

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THL Vaikuttajaseminaari 3.-4.10.2013, Stefan Jönsson

THL Vaikuttajaseminaari 3.-4.10.2013, Stefan Jönsson

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Choosing health care center – preconditions for competition on quality Choosing health care center – preconditions for competition on quality Presentation Transcript

  • Choosing health care center – preconditions for competition on quality (Stefan Jönsson Helsingfors 2013-10-04) Bild: Istock
  • Background In 2011 the Swedish Competition Authority was assigned by the Government to • analyze the development of diversity within primary health care and to • analyze the preconditions for competition on quality within the system of choice in the health care sector The report ”Choosing health care center – preconditions for competition on quality” was presented in february 2012
  • The Swedish Competition Agency’s follow up of the choice of health care center reform • The Swedish Riksdag decided 2009 that all county councils (landsting) should introduce systems of choice of health care centers in 2010. • The report Choosing health care center (Val av vårdcentral) was presented in 2012 • In august 2013 SCA were given a new task to follow up the reform • A new report will be presented in february 2013
  • Diversity (mångfald) of health care centers after the introduction of systems of choice • The number of health care centers (vårdcentraler) had increased 19 percent (by 190) since the introduction of systems of choice • 267 new health care centers, 77 had closed down • The number of health care centers had increased in 19 of 22 county councils (landsting) • There sere 247 different providers of health care (vårdgivare), whereof 22 public and 225 private • 192 providers had only one health care center
  • Three of the ten biggest providers are private Provider Number of health care centers before the introduction of systems of choice Number of health care centers in october 2011 Number of listed patients (2011) Västra Götaland 115 114 1 068 639 Skåne 87 87 838 382 Praktikertjänst AB 49 80 626 670 Stockholm 73 70 769 437 Östergötland 36 34 362 650 Carema Sjukvård AB 31 33 339 376 Norrbotten 32 32 225 356 Västerbotten 32 32 222 528 Jönköping 30 31 262 351 Capio AB 22 30 272 048
  • Preconditions for competion on quality • Competition when the prises are fixed • Factors the patients can observe – i.e. availability (opening hours) and attitude (bemötande) • The county councils are responsible for the medical quality • Preconditions for competition on quality: - Patients must be aware of the possibility to choose - Patients must have at least two alternative health care centers to choose between - Patients must have enough information about the alternatives
  • Almost all patients were aware of the possibility to choose health care center • In more than half of the county councils more than 95 percent of the patients/inhabitants were aware of the possibility to choose health care center • 92 percent of the patients/people asked knew that they can choose which health care center to go to
  • 81% 82% 83% 86% 87% 87% 88% 89% 90% 94% 95% 95% 95% 95% 96% 96% 96% 97% 97% 97% 99% 99% 19% 18% 17% 14% 13% 13% 12% 11% 10% 6% 5% 5% 5% 5% 4% 4% 4% 3% 3% 3% 1% 1% Stockholm Västerbotten Örebro Västernorrland Tiohundranämnden Kalmar Uppsala Värmland Östergötland Gotland Blekinge Norrbotten Skåne Västmanland Gävleborg Halland Jämtland Jönköping Sörmland Dalarna Kronoberg Västra Götaland Did you know that you can choose which health care center to go to/be listed at? Ja Nej
  • Most patients could choose between two health care centers • 79 percent of the inhabitants in Sweden had less than five minutes longer distance (by car) to the health care center that is second closest to their home (compared to the closest health care center)
  • Difference in distance between the nearest and the second nearest health care center 2011
  • Two out of three patients/inhabitants said that they had got enough information about the alternatives • 64 percent of all people asked answered that they had got enough information • In two county councils (Uppsala and Örebro) less than half of the inhabitants said that they had got enough information about the alternatives
  • 45% 48% 51% 53% 55% 57% 58% 60% 60% 62% 62% 64% 65% 66% 68% 70% 72% 72% 77% 79% 79% 81% 7% 15% 19% 8% 14% 15% 15% 16% 10% 7% 12% 12% 14% 11% 10% 10% 13% 6% 14% 10% 7% 9% 49% 37% 31% 39% 31% 28% 26% 24% 30% 31% 26% 24% 22% 22% 22% 20% 16% 22% 10% 11% 14% 10% Örebro Uppsala Stockholm Västerbotten Tiohundranämnden Västmanland Jämtland Halland Kalmar Västernorrland Värmland Östergötland Skåne Dalarna Gotland Gävleborg Sörmland Norrbotten Västra Götaland Kronoberg Blekinge Jönköping Do you think that you have got enough information to make an active choice of health care center? Ja Vet ej Nej
  • Neutrality • Private providers often argue that the county councils give their own health care centers better prerequisities • Public health care centers argue that they have other prequisites than their private competitors
  • In more than half of the county councils the public health care centers run with deficit • In some county councils almost all health care centers run with deficit • In some other county councils deficit were caused by demands to run health care center even if the costs were not fully covered by the pay (i.e. in lesser populated areas) • Deficits indicates that the pay is too low or that the health care centers are inefficient • The economic results were not always reported to the responsible boards and/or polititians
  • Our proposals: • County councils should continue to develop and follow up the systems of choices in the health care sector. • The county councils should apply equal conditions for their own and for privat health care centers. Any differences in the responsibilities should be clear and paid for separately. The economic results of every health care center should be made public. • The county councils should develop the information about the systems of choice and about the health care centers • Relevant statistics on the systems of choice should be gathered for research and following up
  • Val av vårdcentral Förutsättningar för kvalitetskonkurrens i vårdvalssystemen Bild: Istock