No proven health impact of free primary care

introduction of the abolition of co-payments in Swedish primary care aged 85 and over has not caused an increase in health care visits. When it comes to achieving the intended effects, reforms appear to have failed, says a study from the University of Gothenburg.

Research published in Journal of Health Economicsis based on 2014-2018 registration data for the Stockholm and Vestra Gotaland regions. Nationwide, starting in 2017, primary health care was free for those 85 and older.

By waiving fees for primary care for these patients, the decision makers’ intention was, among other things, to reduce the risk that older people choose not to seek the care they actually need. Out-of-pocket costs were seen as a problem for those with severe care needs and frequent hospital visits, despite caps (annual caps) being set.

The results of the current study indicate that this risk is insignificant. Elderly people in her two regions surveyed generally did not avoid seeking medical care because of the cost of the consultation.

some visits were delayed

What the researchers found was that people nearing the 85-year-old mark could delay their primary care visit by up to four months. Only applied to other scheduled appointments or follow-up visits.

The study’s first corresponding author, Naimi Johansson, holds a PhD from the Sahlgrenska Academy at the University of Gothenburg, where the study was conducted. She is currently a health economist in the Orebro county area.

“People nearing the age threshold for free primary care postpone some visits, but there is no evidence in studies that delays in these visits have a serious impact on their health. No,” she points out.

Health-free redistribution

From an economic point of view, waiving these fees means redistributing public resources from the country to the sick elderly. However, the surveyed regions were unable to demonstrate major health effects measured in terms of mortality and hospitalization.

One of the unintended consequences of deferred visits is that age thresholds for fee waivers have resulted in some change in healthcare costs. Region Vestra Gotaland reduced costs by approximately SEK 265,000 per year, while Region Stockholm increased by approximately SEK 501,000 per year.

The decrease in Region Västra Götaland was attributed to fewer visits to non-physician health professionals by older patients in the month immediately preceding the patient’s 85th birthday. In rural Stockholm, visits of this kind postponed before the patient’s 85th birthday were replaced with doctor’s visits after the relevant date. This research study is a collaboration between Gothenburg University, Regional Örebro County, Örebro University, and Monash University. Australia.