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Evaluation of Primary Care in Sweden: Manning, Funding, and Training Needs

This report evaluates various aspects of primary care in Sweden including staffing levels, funding, and the need for further specialized training. It also compares Sweden's primary care system to other OECD nations and examines the costs and production of primary care. The report concludes with recommendations for improving the coordination and continuity of care.

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Evaluation of Primary Care in Sweden: Manning, Funding, and Training Needs

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  1. Evaluation of vårdval in primary care Swedish medical association • Survey of manning in primary care 2013 • Report about funding and economy in primary care 2014 • Report about the external conditions in special training 2014 • Inquiry to all members of the Swedish union of general practitioners 2015

  2. Survey of manning nov 2012 Swedish Medical Association

  3. Results- number of different specialists in primary care, calculated as full time employees Fasta Längre vik Totalt % Family medicin 3 888 651,9 4 539,8 95% Geriatrics 39,7 8,3 48 1% Pediatricians 30,6 4,635,1 1% Gynecologists 10,5 0,8 11,30% Other specialists 105,4 44,6 1504% Summary 4 074,1 710,14784,3 100 % 8 procent were 65 year or older

  4. Vacancies – primary care units (PCU) have the need and economy for employing more GPs • 858 full time GPs • 41 % of all PCUs (50 % off all public and 28 % of all private PCUs)

  5. ”Rental doctors ” - in Swedish primary care

  6. Number of listed patients/GP in all counties and regions

  7. Percentage private GPs in all counties and regions.

  8. Percentage PCUs who can afford and need to emply a GP

  9. The situation on special training (ST) • 1 863 ST-doctors in family medicine • 33 ST-doctors in other specialities

  10. The need for further ST-doctors • To be fully manned in 2017 • + 958 with actual resources (+ 50 %) • + 1 679 to be 1 GP/1500 inhabitants (+ 90 %) • 61 % of PCUs needs more ST-doctors • 31 % are in balance • 8 % have more ST-doctors than their actual need

  11. Overall results from november 2012 The number and needs for specialists in family medicine Total number including substitutes 4 800 The needs with actual prerequisites 5 700 + 20 % The needs with an aim at 1 GP/1500 inhabitants 6 200 + 30 % The number ande needs for doctors in special training (ST) The actual number of ST 1 850 The needs with actual prerequisites 2 800 + 50 % The needs with an aim at 1 GP/1500 inhabitants 3 500 + 90 %

  12. Prognosis

  13. Costs and production in primary care • Comparisons before and after the introduction of vårdval

  14. International comparisons

  15. Sweden has a peculiar organisation of care compared to other OECD-nations 1 - Least number of visit to the doctor/inhabitant2 - Almost most doctors/population 3 - Least number of patientvisits/ doctor4 - Least share of GPS in OECD5 - Least share of patients with a personal GP 6 Least number of hospital beds/inhabitant Results of Swedish health careGood results but very poor in coordination and continuity

  16. The change of costs of different sectors of Swedish health system 2001-2012

  17. …. drugs excluded

  18. The relative cost of primary care and general practitioners in swedish counties and regions

  19. The relative change of number of visits to doctors in different healthcare sectors/year

  20. The relative change of the number of visits to a GP/inhabitant 2002-2012

  21. Conclusions • Sweden has very few visits to doctors/population , low share of primary care practitioners and relatively low ratioof patients with a permanant doctor in primary care • Primary care has increased its role in urban areas hads decreased its role in rural parts in the north. • The costs for general practitioners and nurses has increased since 2000 • The primary cares share of all visits to doctors has increased 10% 2001-2012

  22. Survey on ST in family medicin -an analysis of recruiting and planning and thoughts about how to increase the dimensioning

  23. Survey adressed to swedish directors of studies in family medicin • Questions • How do your region plan, dimension and recruit doctors for spescialist training in family medicin? • Are there any analysis concerning future needs (planning and dimensioning)? • What is the role of PCUS in planning?? • Who is responsible for recruiting ? • Funding?? • Survey of number of ST 2013. • - Has it changed since the 2012 survey ??

  24. Planning, dimensioning and analysis of future need • Most counties have some kind of coordination concerning planning and dimensioning – but with great variations • Most counties have some kind of unqualified analysis • Most counties have no central coordination of planning, recruiting,recruiting and analysis

  25. Focus group results • Factors of success • Family medicn and primary care gives a possibility to combine family life on equal footings and professional development • Continuity and the personal relation • Factors to change • Monotonous and high workload • Communication and coordination with specialized care. • Indistinct decisionmakers. • The negative trademark

  26. Propositions- on three levels 1.National: Coordination, stimulance and follow-up 2.Regional: Development of structures for dimensioning, planning , recruiting and funding ST in family medicin 3. Local: Regionally certified PCUs for supervising ST. Extra reimbursement for certified PCUs

  27. Conclusions of all reports • Increeasing regional unequalities • Primary care poorly financed • Increased need for more ST-doctors in family medicin now!!

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