Who wants to know what to choose?

One of the tasks of the Swedish Agency for Health and Care Services Analysis (Vårdanalys) is to constantly evaluate the information provided by the healthcare and medical care services to individuals.

According to the Swedish Health and Medical Services Act (1982:763), since 2010 all county councils have been obliged to offer the opportunity to choose a primary care provider. One prerequisite for people having equal opportunities of choice is having the information available to support an informed choice. According to the Swedish Systems of Choice Act (2008:962, LOV), the county councils are therefore obliged to offer information on all providers with whom they have drawn up a contract. According to the Act, the information must be objective, relevant, comparable, easy to understand and easily accessible.

Against the background of the above legislation, in August 2013 Vårdanalys published an assessment of the information on healthcare choice from a patient’s and citizen’s perspective. The general public’s need for information to make a choice, and the question of whether or not they felt that this information was available, was examined through a survey. In brief terms, the study showed that 76 per cent of people regarded it as important for people to be able to choose their medical centre, while 95 per cent were aware of the option to choose. Only a small proportion expressed clear dissatisfaction with the information as a whole. Around 60 per cent of those who had changed medical centre considered the information to be easily available, relevantly up-to-date and correct. On the other hand, only around a fifth of those who had changed or considered changing medical centre considered it was possible to compare the similarities and differences among the medical centres on the basis of the information. The majority of respondents found the information they were searching for, though there was a certain demand for information that is not currently available. For example, 84 per cent asked for information on the hygiene and cleanliness of the medical centre and 80 per cent asked for information about the medical centre’s ability to coordinate healthcare contacts and offer continuity in doctor’s appointments. Five per cent had searched for information about medical quality, but not found the information. The most common sources of information were family and acquaintances, the medical centre that people wished to switch to, and the county councils’ websites.

PURPOSE AND IMPLEMENTATION OF THE STUDY

The purpose of this study is to contribute a knowledge base that can be used to support the development of healthcare information in primary care. The study examines what information different groups of people – based, for example, on gender or socioeconomics – wish to have in order to choose their primary care provider. Differences among the various groups are examined through multiple logistic regression analysis of the survey data collected by Vårdanalys in the previous study on healthcare choice information.

The questionnaire survey took the form of an online survey that reached respondents aged 18–85 years via an online panel drawn up by the Swedish Institute for Opinion Surveys (SIFO). In order to achieve a high level of statistical precision, a net selection of 3,300 respondents was calculated. A total of 3,354 respondents were included in the study.

SIFO’s panel includes around 100,000 people and is representative of at least 90 per cent of the adult population in Sweden. According to SIFO, known defects in the panel are that there is an underrepresentation of the elderly, the unemployed, people with a lower level of education, people of lower income and people with a different ethnic background. It also excludes people who have no command of Swedish or no Internet access. The lack of Internet access affects all groups studied, but has a particularly large impact on the elderly group as we know that many in this group have no access to the Internet. Given this background, the results of the study should be interpreted with a certain degree of caution.

OVERALL RESULTS

A fundamental assumption in this study is that the knowledge that there is a choice, and the willingness to choose, affect the interest in the information. If people are unaware of, or not interested in, the possibility of choosing it is likely that this will reduce their interest in the information. This study indicates that the option to choose a primary care provider is considered particularly important among women, people with chronic illness, people with a lower level of education and the elderly, but less important among those who live in smaller places, people of lower income, people with a higher level of education and the young. Those living in smaller places also often state that they are “tired of all the choices you need to make in the community” and that this is a reason why they do not choose to change medical centre. It often appears that women, people with a higher level of education and the elderly are aware of healthcare choice to a greater degree than are men, people with a lower level of education and the middle-aged. Younger people often have less knowledge of healthcare choice than do the middle-aged.

A fundamental assumption in the study is also that a person’s interest in healthcare information is influenced by whether that person has a current need for the information. It may be expected that those who face a choice or a change of medical centre would be in greater need of information on healthcare choice than those who already attend a medical centre with which they are satisfied. The previous study by Vårdanalys showed that 64 per cent of the general public had either changed or considered changing their medical centre during the past three years. A total of 24 per cent had changed and 11 per cent indicated that they were considering changing. This study indicates that women, people with a higher level of education and young people change or consider changing medical centre more often, while people with a lower level of education and those living in smaller places more often do not change.

The opportunities to choose and change medical centre can also be governed by the accessibility of alternatives. The results indicate that those living in smaller places more often state that they do not change medical centre because there are no alternatives close by. On the other hand, people living in the big cities more often consider that the barrier to choosing a medical centre is the lack of useful information, or the fact that it takes too long to choose. This shows that the conditions for choosing a medical centre can be very varied depending on where in the country the person lives.

What information do the various groups of people want, therefore? This study shows the following central results:

• Gender, age, education level and the reason for changing medical centre affect the information that people want

Gender, age, education level and the reason for changing medical centre are the background factors that most strongly affect the amount of information sought by the respondents, what information they want and whom they prefer as the providers of the information.

• Women and the elderly attach greater importance to the information

Women and the elderly appear generally to have searched for more information and usually show greater interest in almost all information on the services on offer and quality of the medical centres. Both groups have more frequent contact with primary care, which may explain why they attach greater importance to information on healthcare choice. As mentioned above, women also often belong to the group that have changed or considered changing medical centre more often, which may be an additional reason why they regard the information as more important.

• Men and people who specify having moved home as a reason take on less information

Those who have specified moving home as a reason for changing make up around 40 per cent of those who have changed medical centre in the past three years and a fifth of those who have considered changing. Those who have specified moving home as a reason, and the group “men”, are distinguished by almost always appearing less interested in healthcare information. Men’s lower level of interest in information may be an effect of the fact that, compared with women, they do not visit the healthcare services to the same extent, or regard making a choice as less important. There are various ways of interpreting the fact that those who have indicated moving home as a reason for changing show less interest in information. One assumption was that they should have a greater interest in information in the absence, for example, of knowledge about the new place, previous experience of the medical centres or small social networks. At the same time, their change of medical centre is primarily governed by moving home and not by an active dissatisfaction or desire to find a better medical centre. It may also explain why their level of interest in information is lower compared with groups that move for more “active” reasons.

• Education more than income affects the need for information

The results indicate that education has a greater effect on the desire to obtain information than does income level. In general, people with a higher level of education appear to search for more information than do people with a lower level of education, and they have more often searched specifically for certain information about the medical centres. For example, this may be information about the expertise found at the medical centre and the way in which the medical centre is run. At the same time, people with a lower level of education regard clinical results as more important when making the choice than do people with a higher level of education. This is an interesting result as previous studies had shown that people with a higher level of education usually factor in information about clinical quality when they choose.

• People’s living circumstances affect the information they wish to receive

People with chronic illness, worse perceived health and families with children often have a recurring healthcare need. One assumption was that these greater healthcare needs would lead to more active search behaviour and a greater interest in information about the medical centres’ clinical results, for example. However, the results only partially support this picture. People with chronic illness, worse perceived health and families with children do not appear to search for any more information than others and do not consider the medical quality as more important for their choice. On the contrary, it appears that they attach greater importance to information that specifically relates to their living circumstances, for example information on opportunities for continuity, whether the medical centre can offer a special surgery, e.g. a diabetes clinic, and duty hours.

• The elderly often have less confidence in the Internet as a channel for healthcare choice information

The high level of trust in families and acquaintances, the medical centres and county councils’ own website as providers of healthcare choice information do not vary to any great extent with people’s background factors. One exception is that people with a lower level of education often appear to turn to or trust in the county councils as providers to a lesser extent than do people with a higher level of education. It is also interesting to note that the elderly appear to trust less in Internet-based sources, while the trust among younger people is generally greater. This shows that there is still a digital gulf as far as the Internet is concerned as a source of information.

• Women and the elderly have a higher opinion of the comparability of the information

A central requirement if the public’s choices are to provide stimulation for competition and quality development is access to comparable information about the differences and similarities between medical centres in terms of the various quality dimensions. This study shows that women and the elderly agree to a greater extent that the information was comparable, while people who have indicated moving home as a reason for changing and those with a higher level of education do so to a lesser extent.

THE IMPORTANCE OF THE RESULTS FOR THE CONTINUED DEVELOPMENT OF HEALTHCARE CHOICE INFORMATION

The results of the study show that there is a breadth of information that people request in order to be able to choose. There are also differences in the amount of trust placed in the various providers of healthcare choice information as well as in from whom people wish to receive the information. The county councils and SALAR are currently working to develop healthcare choice information for the purpose of providing support for well-informed choice. The work done to produce new healthcare choice data should be based on the specific wishes of the public and the groups. When reporting information, it is important to enable people to find out the information that they personally consider to be important. This helps to make healthcare choice information more relevant and usable for those people who need to make a choice.

The previous study on healthcare choice information by Vårdanalys showed that the public had searched for information to only a very limited extent, and that they were generally satisfied with the information currently available. For this reason, any development of healthcare choice information should – in line with the statutory requirements – be done on the basis of balancing the cost against the expected benefit in the short and the long terms. The most important remaining development need is for improved opportunities to compare differences and similarities among the various medical centres. This survey does not include people with no access to the Internet or no knowledge of Swedish. Further studies are therefore required in order to gain a better understanding of the healthcare choice information that these groups require.