Value-Based Inspired Reimbursement Model for Primary Care

Sammanfattning: Primary care in Sweden is experiencing a continuous increase in costs, difficulties in delivering intended care, and uneven quality for patients. Analysts are concerned with how to improve the quality of the care provided while controlling the healthcare expenditures. The importance of the manner in which primary care is reimbursed is well recognised, but the optimum design of a reimbursement model is under debate. Structurally different reimbursement models can create incentives for innovation initiatives aiming to improve the processes, efficiency and quality in the care provided. Despite this, there is scarce research on how reimbursement models can incentivise innovation. Stockholm County initiated a pilot project in January 2016 with the intention to test a new reimbursement model at four primary care centres in Stockholm. The aim of the reimbursement model is to allow for greater freedom to innovate while increasing quality and maintaining accessibility. The purpose of this study is to investigate how this reimbursement model afford primary care practitioners to pursue different innovations. Twenty-one interviews, with 5 initiators of the project and 16 members of the participating primary care centres have been conducted in a multiple case study. The results indicate that the reimbursement model afford primary care practitioners to pursuance an overarching strategic goal to improve care for patients, especially elderly chronically ill, and multi-sick patients. Incentives concerning longer appointments, accessibility, and redesigned processes providing more responsibility for nurses are the areas which receive most attention. The study thereby advances the knowledge of reimbursement models and innovation, and what design features that may shape this relationship.