Productivity and patient satisfaction in primary care--conflicting or compatible goals?

Following recent reforms in Swedish primary care, providers are accountable to both citizens and county councils, in their role as payers. Productivity and quality measurement is fundamental for ensuring health care providers accountability to payers and that resources are spent as intended. The purpose was to study productivity and patient satisfaction in Swedish primary care. One measure of productivity capturing volume of visits and one measure capturing individual's judgment about the quality of services in relation to allocated resources was estimated. The potential conflict between the two measures and variation with respect to different factors was analyzed. There was a great variation in both measures of productivity. No conflict between the two measures of productivity was found. Thus, most providers could increase their volume of services without adverse effects for the quality and vice versa. Providers are however faced with different conditions. Traditional productivity measures are not enough to assess whether allocated resources are used according to set priorities and generates value for money. Information about the length and content of visits and the distribution of services produced is also needed, in particular to assess if resources allocated based on expected great needs among certain groups actually benefits those individuals. Effects of services produced are also needed. This is particularly important to assess if resources allocated based on expected great needs among certain groups actually benefits those individuals.