Private and public quality of care- a comparison of pressure sore prevalence in Swedish care homes

Abstract: This paper compares the quality of private and public health care, by studying Swedish care homes for elderly and disabled persons. The outcome of interest is the prevalence of pressure ulcers. Pressure ulcers are partly preventable by for example care home staff routines, nutrition and movement plans. As pressure sores is one of the most common healthcare injuries, comparisons of pressure sore prevalence between private and public nursing homes have been carried out previously. Prior studies generally show that pressure sore prevalence increases from private ownership. This paper’s contribution to the literature is to include a pressure sore risk measure in the analysis, to include 5 different categories of care homes and to carry out a study in the Swedish care home sector. Data is gathered from the Swedish quality register Senior Alert on care home unit level for the years 2017-2022. A two-way fixed effects model is applied, and mediation analysis is performed. The results entail that in Sweden, private ownership has a negative significant effect on pressure ulcer prevalence in nursing homes, and for the restricted sample of municipalities in which no guaranteed choice of care home is given. As for the other analyses and home types, no significant effect is found in comparison to public units.