Population preferences and choice of primary care models: a discrete choice experiment in Sweden

To examine which attributes are important when individuals choose between primary care models. In particular, we studied whether individuals that were given a choice preferred individual family physicians (GP) or a primary care team consisting of physicians and nurses (PCT).

A questionnaire survey, designed as a discrete choice experiment, was sent to 1600 individuals in Sweden. In the questionnaire, different primary care models were constructed on the basis of five attributes: GP versus primary care team, waiting time for non-emergency visits, user charges, ability to choose provider, and degree of influence over the care received. Individual preferences and willingness to pay for attributes were regressed against such characteristics as age, gender, education, and health status (as measured by EQ-5D).

The response rate was 58%. Waiting time, user charges, ability to choose provider, and degree of influence over the care received were each statistically significant discriminants (p<0.001). Willingness to pay per visit was 224 SEK for great compared to limited degree of influence over the care received, 164 SEK for ability to choose a provider and 111 SEK for each 1 day reduction in waiting time for non-emergency visits. Subgroup analysis showed that older individuals and individuals in poor health preferred the option to register with a GP whereas working individuals and individuals living at a greater distance from a hospital preferred the option to register with a primary care team.