Weak Association Between Socioeconomic Care Need Index And Primary Care Visits Per Registered Patient In Three Swedish Regions

Objective The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status. Design Observational study combining graphical analysis with linear regressions of cross-sectional administrative practice-level data. Setting Three Swedish regions, Vastra Gotaland, Skane and ostergotland (3.5 million residents). Outcomes were measured in February 2018 and the CNI was computed based on data for 31 December 2017. Subjects The unit of analysis was the primary care practice (n = 390). Main outcome measures i) Number of GP visits per registered patient; ii) Number of nurse visits per registered patient; iii) Number of morbidity-weighted GP visits per registered patient; iv) Number of morbidity-weighted nurse visits per registered patient. Results The linear associations between the CNI and GP visits per patient were positive and statistically significant (p<0.01) for both the unweighted and weighted measure in two regions, but the associations were mainly due to 10 practices with very high CNI values. The results for nurse visits varied across regions. Conclusions For most levels of the CNI, there was no association with the number of consultations provided. This result may indicate insufficient compensation, weak incentives to spend the money, decisions to spend the money on other things than consultations, or stronger competition for patients among low-CNI practices. The result of this observational study should not be taken as evidence against the possibility that the CNI adjustment of capitation may have affected the socioeconomic equity in GP and nurse visits.