The abolition of co-payments in basic care for over 85-year-olds did not lead to an increase in visits to the doctor

The introduction of the abolition of co-payments in primary care in Sweden for the over 85s has not led to an increase in the number of doctor visits. In terms of the intended effect, the reform seems to have failed, as a study by the University of Gothenburg shows.

The study, published in the Journal of Health Economics, is based on registry data from 2014-2018 in the Stockholm region and the Västra Götaland region. Since 2017, basic care has been free nationwide for people over the age of 85.

By waiving these patient user fees for basic care, the decision-makers primarily wanted to reduce the risk of older people forgoing the medical care they actually need. For those who had major care needs and required repeat visits, the deductible fees, despite their cap (the annual cap), were seen as problematic.

The results of the current study indicate that this risk is negligible. Older people in the two regions surveyed did not generally shy away from using health care because of the consultation fee.

Some visits are delayed

What the researchers found was that people approaching the 85-year mark were able to delay primary care visits by up to four months. However, this did not apply to doctor consultations, only to other scheduled appointments or check-ups.

The first and corresponding author of the study, Naimi Johansson, holds a PhD from Sahlgrenska Academy, University of Gothenburg, where the study was conducted. She is now Health Economist in Örebro County Region.

People approaching the age limit for free primary care delay some visits, but we see no evidence in the study that these delayed visits have any serious impact on their health.”

Naimi Johansson, first and corresponding author of the study

Redistribution without health effects

From an economic point of view, the waiver of these taxes means a redistribution of public funds from the state to sick seniors. However, no major health impacts, measured in terms of mortality and hospital admissions, could be demonstrated in the regions studied.

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An unforeseen consequence of the postponed visits was that the fee exemption age limit brought some changes to healthcare costs. In the Västra Götaland region, costs fell by approximately SEK 265,000 per year compared to an increase of approximately SEK 501,000 per year in the Stockholm region.

The decrease in the Västra Götaland region resulted from fewer visits by elderly patients to non-physician health workers in the months leading up to the patient’s 85th birthday. In the Stockholm region, such visits that were postponed before the patient’s 85th birthday were replaced by visits to the doctor after the dates in question.

The research study is a collaboration between the University of Gothenburg, Örebro County Region, Örebro University and Monash University, Australia.


Magazine reference:

Johansson, N. et al. (2022) Light therapy as a non-pharmacological treatment option for multiple sclerosis-related fatigue: A randomized sham-controlled trial. Journal of Health Economics.

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