Lars Norén

Decision support systems for choosing a primary health care provider in Sweden

OBJECTIVE To evaluate how patients are supported with information and other forms of Web-based decision support for making an informed choice of a primary health care provider. METHODS The article is based on a comparative case study of recently developed tools provided by Web portals in Sweden (one national, three regional). The theoretical framework for analysis is the general calculation model, including the steps of isolating, examining, and ranking available options. RESULTS The provision of information and other forms of support is reasonable when it comes to isolating a particular alternative or presenting a general view of alternatives. As for examining and ranking, one regional system and one national system offer support based on information from patient surveys and waiting times, and one regional system offers support based on provider competencies. CONCLUSION One design alternative is to represent the opinions of patients about care centers, another is to represent the characteristics of care centers, and a third is to combine the two. The general calculation model is relevant as a framework for analysis from a practical as well as a theoretical viewpoint. PRACTICAL IMPLICATIONS The study provides practical examples of decision support for patient choice in primary health care.

Promoting competition in Swedish primary care

PURPOSE The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare. DESIGN/METHODOLOGY/APPROACH The paper uses a mixed-method research methodology to analyse two primary healthcare ADs in two Swedish regions. In total, 19 interviews were conducted with actors involved in the creation and use of such documents. FINDINGS This paper points to the crucial role of ADs in the identification of quality differences that influence the competition in primary healthcare. This finding contrasts with the commonly held laissez-faire idea that competition causes providers to develop their own service concepts and where the invisible hand creates quality differences. The paper adds to the discussion with its detailed description of how ADs create competition among primary healthcare providers through selection processes, quality differentiation, and ranking. RESEARCH LIMITATIONS/IMPLICATIONS The paper does not explore quality differences in the medical treatment of patients in primary healthcare centres. PRACTICAL IMPLICATIONS The paper provides insights for politicians on how to use ADs to control competition and regulate choice. ORIGINALITY/VALUE The paper takes an innovative approach to the examination of how ADs increase the competition in primary healthcare choice.