Operating performance at the cost of primary care quality? A study of the impact of ownership in Swedish primary care

Abstract: This thesis investigates Swedish primary care by analysing if the ownership structures of the market participants affect primary care quality and operating performance. Four different types of ownership are identified - public, private equity, franchise and other private - and these are used to analyse whether primary care quality in Swedish health centres differ based on ownership. We use panel data from a patient survey covering the majority of Swedish health centres during 2009, 2010 and 2011. Furthermore, the operating performance analysis uses financial metrics to compare primary care companies owned by private equity firms with primary care companies owned by comparable private firms. We find that private ownership and franchising ownership are superior in delivering high primary care quality while private equity owned health centres provide an equal level of primary care quality as public health centres. We also find that private equity companies are superior to comparable private companies in operating performance.