Inequity in a digitalized primary healthcare - a study of healthcare utilization in Sweden 2022-2025

Background

A large-scale implementation of a service for digital physician consultations is ongoing in the publicly funded primary healthcare system in Sweden. Previous studies on similar services operated by private companies have shown increased access predominantly for patients of high social status. This study aims to answer the question of how this new publicly operated digital service affects equity in access to healthcare, a very important issue since digital healthcare services are expanding globally and affecting large populations.

Methods

Longitudinal study using individual data from the entire population of Region Scania in Sweden (1.4 million people) comparing utilization of in-person and digital primary healthcare. Repeated logistic regression analysis over time and equity analysis by stratifying data by socioeconomical factors. The outcome measure is binary, 1 if at least 1 registered physician consultation and 0 if no registered physician consultations for one year.

Results

Preliminary data from one study year, adjusted for age and sex, show that being born in Sweden (OR 2.1, 95% CI 1.66 – 2.66), having a tertiary education (OR 1.69, 95% CI 1.43 – 2.03) and highest decile of income (OR 2.66, 95% CI 1.95 – 3.67) are strongly associated with the use of digital physician consultations. We also found that in-person physician consultations were positively associated with being born in Sweden (OR 1.17, 95% CI 1.16 – 1.18) and having the highest decile of income (OR 1.05, 95% CI 1.03 – 1.07) while being negatively associated with having a tertiary education (OR 0.56, 95% CI 0.55 – 0.57).

Conclusions

The results indicate that digital physician consultations are used more frequently by patients of higher social status. Actions need to be taken to ensure that resource allocation is based on need for healthcare and equity by informing policy makers of these results, especially since digital healthcare services are expanding globally.

Key messages

• Digital healthcare services are implemented on large-scale. Progress is fast and precedes evidence.

• Our study shows that implementation of digital physician consultations risk reducing equity in access to healthcare.