The construction of a customer of primary health care

Abstract

A new quasi-market model commonly referred to as a “choice of care” model is introduced in Swedish primary health care. In such models citizens are expected to choose primary healthcare centres they want to be treated by. The care centres are expected to compete based on differences in the quality of the services they provide in the market. In this paper the accreditation document (AD) and the way it specifies the regulated choice of the patient is explored. Two case studies of primary care markets in Sweden is the empirical point of departure. The conclusion is that the ADs define the conditions for the choice of care. The ADs define an almost unconditional right for the patient to choose between care centres of a specified minimum level of quality based on political requirements. The ADs also specify a procedure for payment – a voucher – that follows the pa- tient to the chosen care centre. Finally, the ADs specify procedures of quality evaluation that create differences between care centres. The AD in itself contributes actively to the market because it specifies the requirements of a McPatient. Primary healthcare centres respond to the AD even if patients do not make any choices.