Continuity of care in the context of a primary health care reform: a follow-up after the Swedish Patient Choice Reform.

Abstract

Background: Continuity of care (CoC) is essential for effective primary health care (PHC), yet Swedish PHC has historically exhibited low levels of continuity. The Swedish Patient Choice Reform introduced privatization and market-oriented principles into PHC, leading to increased utilization and growing inequities in service use driven by socioeconomic disparities and misalignment with health care needs. However, little is known about its impact on continuity. The aim of this study is to explore long-term effects of longitudinal CoC in PHC within the context of the Patient Choice Reform.

Methods: Using register data from Region Skåne (2007-2017), we created three closed cohorts, each capturing three years of PHC utilization. Continuity with GPs was measured using the Continuity of Care Index (CoCI). Quantile regression assessed associations between continuity and individual characteristics, including age, sex, income, education and residence.

Results: Among 322,641 individuals with 7,878,642 general practitioner (GP) visits, median CoCI declined from 0.17 (2007 cohort) to 0.13 (2015 cohort). Higher age, male sex and increased PHC utilization were linked to greater continuity in 2007, but these associations weakened by 2015.

Conclusions: Continuity of care in Swedish PHC declined over time, particularly among older individuals and frequent PHC users. These findings highlight the need to address continuity deterioration in the context of the Patient Choice Reform.