Background
The choice reform in primary care
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Did the visits increase more in groups with greater health care needs?
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Did the visits increase more in disadvantaged areas?
Methods
Variables
Health care utilization
Health status measures used as indicators for need of health care
Self-rated health and limiting longstanding illness
General Health Questionnaire-12 (GHQ12)
Disability pension
Disadvantaged areas
Age
Education
Statistical methods
Results
Change in number of visits
2007 | 2011 | Change | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean number of visits | % with 1 or more visits | Mean number of visits | % with 1 or more visits | Change in mean visits | CI 95 % (Low) | CI 95 % (High) | Change in % with one or more visits | CI 95 % (Low) | CI 95 % (High) | |
Women | ||||||||||
Total | 1.99 | 60.84 | 2.84 | 69.90 | 1.43 | 1.38 | 1.48 | 1.15 | 1.13 | 1.16 |
Self rated health (SRH) | ||||||||||
Good SRH | 1.42 | 55.23 | 2.13 | 65.37 | 1.50 | 1.44 | 1.56 | 1.18 | 1.16 | 1.20 |
Less than good SRH | 3.25 | 73.62 | 4.60 | 81.33 | 1.41 | 1.34 | 1.49 | 1.10 | 1.08 | 1.12 |
Limiting longstanding illness (LLI) | ||||||||||
No LLI | 1.49 | 55.73 | 2.21 | 65.76 | 1.49 | 1.43 | 1.55 | 1.18 | 1.16 | 1.20 |
LLI | 3.23 | 73.90 | 4.57 | 81.62 | 1.41 | 1.33 | 1.50 | 1.10 | 1.08 | 1.13 |
SRH and LLI | ||||||||||
Good SRH and no LLI | 1.31 | 53.37 | 1.98 | 63.81 | 1.51 | 1.44 | 1.57 | 1.20 | 1.17 | 1.22 |
Poor SRH and LLI | 3.70 | 76.60 | 5.15 | 83.34 | 1.39 | 1.30 | 1.49 | 1.09 | 1.06 | 1.11 |
Disability pension | ||||||||||
No disability pension | 1.90 | 59.89 | 2.73 | 69.27 | 1.44 | 1.38 | 1.49 | 1.16 | 1.14 | 1.17 |
Disability pension | 3.09 | 73.69 | 4.39 | 80.91 | 1.42 | 1.28 | 1.57 | 1.10 | 1.06 | 1.14 |
GHQ-12 | ||||||||||
No mental health problems | 1.83 | 59.17 | 2.70 | 69.09 | 1.48 | 1.42 | 1.54 | 1.17 | 1.15 | 1.18 |
Mental health problems | 2.45 | 66.03 | 3.10 | 72.18 | 1.26 | 1.17 | 1.35 | 1.09 | 1.06 | 1.12 |
Area | ||||||||||
Deprived areas in Stockholm County | 2.40 | 66.50 | 3.60 | 71.95 | 1.50 | 1.28 | 1.72 | 1.08 | 1.02 | 1.14 |
The rest of Stockholm County | 1.97 | 60.57 | 2.80 | 69.81 | 1.43 | 1.38 | 1.48 | 1.15 | 1.14 | 1.17 |
Age | ||||||||||
25–44 years | 1.36 | 54.56 | 1.78 | 61.92 | 1.31 | 1.24 | 1.38 | 1.13 | 1.11 | 1.16 |
45–64 years | 1.87 | 59.78 | 2.52 | 68.48 | 1.35 | 1.28 | 1.42 | 1.15 | 1.12 | 1.17 |
65–74 years | 2.86 | 71.75 | 4.11 | 82.15 | 1.44 | 1.32 | 1.55 | 1.14 | 1.11 | 1.18 |
75–84 years | 4.28 | 79.82 | 6.16 | 86.03 | 1.44 | 1.31 | 1.57 | 1.08 | 1.05 | 1.11 |
LLI | 3.23 | 73.90 | 4.57 | 81.62 | 1.41 | 1.33 | 1.50 | 1.10 | 1.08 | 1.13 |
Education | ||||||||||
Primary school | 2.51 | 65.86 | 3.52 | 75.68 | 1.40 | 1.28 | 1.53 | 1.15 | 1.11 | 1.19 |
Secondary school | 1.93 | 61.28 | 2.84 | 70.83 | 1.48 | 1.40 | 1.56 | 1.16 | 1.13 | 1.18 |
College | 1.50 | 55.98 | 2.14 | 65.48 | 1.43 | 1.35 | 1.50 | 1.17 | 1.14 | 1.19 |
2007 | 2011 | Change | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean number of visits | % with 1 or more visits | Mean number of visits | % with 1 or more visits | Change in mean visits | CI 95 % (Low) | CI 95 % (High) | Change in % with one or more visits | CI 95 % (Low) | CI 95 % (High) | |
Men | ||||||||||
Total | 1.62 | 50.20 | 2.44 | 59.83 | 1.50 | 1.43 | 1.58 | 1.19 | 1.17 | 1.21 |
Self rated health (SRH) | ||||||||||
Good SRH | 1.16 | 45.36 | 1.80 | 54.90 | 1.55 | 1.46 | 1.63 | 1.21 | 1.18 | 1.24 |
Less than good SRH | 2.80 | 62.62 | 4.32 | 73.82 | 1.54 | 1.42 | 1.66 | 1.18 | 1.15 | 1.21 |
Limiting longstanding illness (LLI) | ||||||||||
No LLI | 1.18 | 45.10 | 1.77 | 54.73 | 1.50 | 1.42 | 1.59 | 1.21 | 1.19 | 1.24 |
LLI | 2.93 | 65.72 | 4.53 | 75.69 | 1.54 | 1.42 | 1.67 | 1.15 | 1.12 | 1.18 |
SRH and LLI | ||||||||||
Good SRH and no LLI | 1.04 | 43.36 | 1.59 | 52.82 | 1.53 | 1.44 | 1.62 | 1.22 | 1.19 | 1.25 |
Poor SRH and LLI | 3.32 | 67.80 | 5.24 | 78.51 | 1.58 | 1.43 | 1.73 | 1.16 | 1.12 | 1.19 |
Disability pension | ||||||||||
No disability pension | 1.55 | 49.54 | 2.37 | 59.22 | 1.53 | 1.45 | 1.61 | 1.20 | 1.17 | 1.22 |
Disability pension | 3.13 | 64.25 | 4.18 | 74.86 | 1.33 | 1.10 | 1.57 | 1.17 | 1.10 | 1.23 |
GHQ-12 | ||||||||||
No mental health problems | 1.57 | 49.11 | 2.36 | 59.03 | 1.50 | 1.42 | 1.58 | 1.20 | 1.18 | 1.22 |
Mental health problems | 1.91 | 55.47 | 2.69 | 62.48 | 1.41 | 1.24 | 1.57 | 1.13 | 1.08 | 1.17 |
Area | ||||||||||
Deprived areas in Stockholm County | 1.83 | 54.90 | 2.53 | 64.84 | 1.38 | 1.13 | 1.63 | 1.18 | 1.10 | 1.26 |
The rest of Stockholm County | 1.61 | 49.97 | 2.44 | 59.60 | 1.51 | 1.44 | 1.59 | 1.19 | 1.17 | 1.21 |
Age | ||||||||||
25–44 years | 0.81 | 40.51 | 1.07 | 46.21 | 1.32 | 1.22 | 1.42 | 1.14 | 1.10 | 1.18 |
45–64 years | 1.45 | 48.81 | 2.10 | 58.37 | 1.45 | 1.34 | 1.55 | 1.20 | 1.16 | 1.23 |
65–74 years | 2.78 | 65.87 | 4.00 | 76.27 | 1.44 | 1.30 | 1.58 | 1.16 | 1.12 | 1.20 |
75–84 years | 4.53 | 77.96 | 5.88 | 82.53 | 1.30 | 1.15 | 1.45 | 1.06 | 1.02 | 1.10 |
LLI | 2.93 | 65.72 | 4.53 | 75.69 | 1.54 | 1.42 | 1.67 | 1.15 | 1.12 | 1.18 |
Education | ||||||||||
Primary school | 1.84 | 53.26 | 3.52 | 67.68 | 1.91 | 1.59 | 2.01 | 1.27 | 1.22 | 1.32 |
Secondary school | 1.49 | 49.82 | 2.84 | 59.86 | 1.91 | 1.39 | 1.62 | 1.20 | 1.17 | 1.23 |
College | 1.21 | 44.90 | 2.14 | 53.71 | 1.76 | 1.36 | 1.60 | 1.20 | 1.16 | 1.23 |
Change in the proportion of individuals visiting the doctor in each group
Changes in equity in health care
Model 0 | Model 1 | Model 2 | Model 3 | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
estimate | sd | 95 % CI | estimate | sd | 95 % CI | estimate | sd | 95 % CI | estimate | sd | 95 % CI | |||||||||
Women | ||||||||||||||||||||
Poor self-rated health (SRH) vs Good SRH | 0.942 | 0.031 | 0.886 | - | 1.001 | 0.947 | 0.030 | 0.893 | - | 1.005 | 0.914 | 0.031 | 0.860 | - | 0.972 | |||||
Limiting Longstanding Illness (LLI) vs no LLI | 0.952 | 0.033 | 0.892 | - | 1.015 | 0.941 | 0.032 | 0.884 | - | 1.001 | 0.915 | 0.033 | 0.859 | - | 0.976 | |||||
LLI and poor SRH vs No LLI and good SRH | 0.923 | 0.038 | 0.857 | - | 0.994 | 0.919 | 0.037 | 0.855 | - | 0.987 | 0.881 | 0.038 | 0.818 | - | 0.949 | |||||
Poor mental health vs Good mental health | 0.854 | 0.038 | 0.793 | - | 0.921 | 0.885 | 0.036 | 0.825 | - | 0.950 | 0.892 | 0.037 | 0.830 | - | 0.959 | |||||
Disability pension vs No disability pension | 1.007 | 0.060 | 0.896 | - | 1.132 | 1.004 | 0.059 | 0.894 | - | 1.128 | 0.989 | 0.059 | 0.881 | - | 1.111 | |||||
Deprived areas vs rest of Stockholm County | 1.053 | 0.074 | 0.911 | - | 1.217 | 0.998 | 0.070 | 0.870 | - | 1.145 | 0.925 | 0.073 | 0.801 | - | 1.068 | 0.900 | 0.075 | 0.777 | - | 1.042 |
Men | ||||||||||||||||||||
Poor self-rated health (SRH) vs Good SRH | 0.998 | 0.043 | 0.918 | - | 1.086 | 1.015 | 0.040 | 0.938 | - | 1.098 | 0.987 | 0.042 | 0.910 | - | 1.072 | |||||
Limiting Longstanding Illness (LLI) vs no LLI | 1.027 | 0.044 | 0.942 | - | 1.120 | 0.986 | 0.041 | 0.909 | - | 1.069 | 0.948 | 0.043 | 0.871 | - | 1.031 | |||||
LLI and poor SRH vs No LLI and good SRH | 1.032 | 0.052 | 0.932 | - | 1.144 | 1.008 | 0.049 | 0.916 | - | 1.110 | 0.964 | 0.051 | 0.872 | - | 1.066 | |||||
Poor mental health vs Good mental health | 0.935 | 0.059 | 0.833 | - | 1.050 | 0.886 | 0.054 | 0.797 | - | 0.985 | 0.860 | 0.055 | 0.771 | - | 0.958 | |||||
Disability pension vs No disability pension | 0.926 | 0.097 | 0.766 | - | 1.120 | 0.925 | 0.094 | 0.769 | - | 1.112 | 0.917 | 0.095 | 0.761 | - | 1.104 | |||||
Deprived areas vs rest of Stockholm County | 0.911 | 0.096 | 0.754 | - | 1.100 | 0.805 | 0.089 | 0.677 | - | 0.958 | 0.783 | 0.092 | 0.653 | - | 0.939 | 0.825 | 0.096 | 0.684 | 0.995 |