Mixed payment and mixed objectives
Insights from the ownership structure in Swedish primary care
Bibliographic Data
| ID | 7176992 |
|---|---|
| Authors | Axel Hellbom Almström (corresponding author), Lina Maria Ellegård (0000-0003-1311-9927), Andreea Enache (0000-0002-7085-0866), Klara Strömberg |
| Year | 2025 |
| Volume | 237 |
| Pages | 107148-107148 |
| Publication date | 2025-08-09 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Economic Behavior & Organization (JOURNAL) |
| Journal identifiers | ISSN: 0167-2681 • E-ISSN: 1879-1751 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.jebo.2025.107148 |
| OpenAlex | W4413143879 |
| Language | EN |
| References cited | 50 |
The literature on ownership in healthcare lacks evidence from the primary care sector, where the traditional small-scale business model is increasingly complemented by larger practices owned by corporations or the government. We explore the role of ownership in primary care in relation to a core theme in health economics — the balance between fee-for-service and capitation remuneration. We study heterogeneous responses to a Swedish policy reform reducing the fee for general practitioner visits and increasing the capitation share in a mixed payment system. In this study context, publicly owned practices, for-profit practices owned by physicians, and practices belonging to chains owned by non-physician investors contract on the same terms. Our difference-in-difference estimates reveal heterogeneity consistent with the notion that profit motives are stronger in externally owned practices: While the number of general practitioner visits generally fell after the reform, the reduction was more marked for practices belonging to chains. The reform did not have a differential impact on patient experience measures. The strengthened incentive to expand the list of registered patients did not have heterogeneous effects. Our results suggest that the design of financial incentives ought to consider that the provider objectives depends on the ownership structure
Business · Family medicine · Payment · Primary care · Health Systems, Economic Evaluations, Quality of Life · Healthcare innovation and challenges · Healthcare Policy and Management · Medicine · Finance
Moral Hazard in Teams
Simply the best? The impact of quality on choice of primary healthcare provider in Sweden
Associations between corporate ownership of primary care providers and doctor wellbeing, workload, access, organizational efficiency, and service quality
Better off by risk adjustment? Socioeconomic disparities in care utilization in Sweden following a payment reform
Competition and Incentives with Motivated Agents
The Proper Scope of Government
Other-regarding behavior and motivation in health care provision
| Citation velocity | historical |
|---|---|
| Highly cited | No |