Context of the study

Swedish primary care is organized in a regulated market (welfare market) with freedom of choice for individuals and competition between providers. There are about 1200 primary care practices in Sweden, of which about 40% are privately operated (Table 1). A clear majority of private primary care providers are for profit. Primary care accounts for about one fifth of the total healthcare expenditures in Sweden. The share varies slightly between county councils. Team-based primary care facilities with different staff categories (GPs, nurses, midwives, physiotherapists and psychologists) is the most common form of primary care practice.

Number of primary care practices, and proportion of private practices in all county councils year 2016/17

County councils, in their role as purchasers, use contracts to allocate resources and tasks to healthcare providers. The contracts are based on financial, organisational and quality requirements that providers must comply with to be allowed to practice primary care are and get publicly reimbursed. It is up to each county council to decide on the specific requirements but the same requirements apply to private and public providers (Healthcare Act SFS 1982: 763 5§; Act 2009: 140). The county councils approve providers who meet the specified requirements and then sign a contract that shows that the provider is allowed to practice primary care and get publicly reimbursed. These contracts are signed between the contract manager in each county council and the managing director at each primary care practice.