Location choice of private primary healthcare providers in Sweden : After the Primary Care Choice Reform

Abstract: This study aims to analyse the location choices made by private primary healthcare providers as a result of the Primary Care Choice Reform. This will be done by analysing a unique dataset covering all new private primary healthcare providers during the time period of 2008 to 2018 in Sweden’s 290 municipalities. In order to examine the probability of a private primary healthcare provider locating in a given municipality, two logit regression models based on the year 2018 containing the number of private primary healthcare providers as the dependent variable, will be used for the empirical analysis. The results are presented as marginal effects and are calculated from the coefficients of the two logit regression models. In addition, there exist alternative measures to the dependent variable when analysing the location choice of private primary healthcare providers. For this reason, an alternative regression will be presented where the dependent variable is the share of healthcare providers in the municipality that is privately owned, to see if any new conclusions can be drawn. There is a broad range of possible determinants for where to locate. Those included in this study are the Care Need Index, political party, domestic net migration, distance, socio-economic variables and a variable measuring the population size. Furthermore, all private primary healthcare providers will be grouped according to which county council they belong to, since all county councils have different reimbursement systems. The findings imply that private primary healthcare providers are, on average, less likely to locate in municipalities defined as rural, compared to municipalities defined as urban. Socio-economic factors such as elderly people and income further influence the location decision, where people with less socio-economic status are at a disadvantage. For this reason, there are some questions about if the objectives of the Primary Care Choice Reform have been achieved and for whom.