Introducing Quasi–Markets in Primary Care: The Swedish Experience

The Swedish experience of introducing quasi-markets in primary care is discussed with respect to the identified objectives of primary care. Empirical studies suggest that objectives related to general accessibility have been met. There is more limited knowledge about the distribution of services between various groups in the population. Problems with coordination and continuity, mainly due to a shortage of general physicians, persist. Costs are controlled but the impact of the reform on the efficiency and effectiveness is uncertain. To maintain and develop governance models, to achieve traditional objectives and to support informed choices among citizens remain important challenges for the 21 county councils. The way forward is likely for county councils to draw on experiences from each other and to harmonize models for governance and support to providers.