Integrated care for older people with complex health problems. How does it affect health, health care utilization and health equity?

PI: Janne Agerholm

The aim of my thesis was to investigate equity in outpatient healthcare. Using register- and survey data from Stockholm County I both evaluated how a policy change in the healthcare system affected equity in healthcare and tested the impact of using different data sources when analysing equity in healthcare.Our findings suggested that inequities in outpatient care do exist in Stockholm. This was most profound among older people aged 65 and above, and especially among older men. We also found an indication of a negative impact on equity in primary care following a change in regulation of- and reimbursement to primary care in 2008. Allocation of financial resources to primary care shifted from low-income areas to high-income areas during 2005-2013 and individuals with mental health problems and women with poor health status had a smaller increase in primary care visits than their respective reference group. In some analyses in the thesis we excluded Norrtälje as this area have another organisation of health and social care than the rest of the Stockholm County. Since 2006 Norrtälje have had an integrated care system that is owned and managed jointly by the Norrtälje municipality and the Stockholm County Council. Integrated care is thought to increase efficiency, quality, and safety while still controlling the costs of care and is advocated as a possible solution to some of the challenges of an aging society. However, robust evaluations of integrated care systems are rare, both in Sweden and internationally.

In this project integrated care will be evaluated against “standard care” for the older population of Stockholm County using an interrupted time series design. Based on register data from 2000-2015 it is possible to follow how the integrated care system have affected health and health care outcomes and to see if this way of organising health and social care could have an impact on the inequalities among the older people found in my previous research.

This project is funded by the Swedish Research Council for Health, Working Life, and Welfare (Forte).