Since 2017, visits to primary care are free of charge for people over the age of 85 throughout the country. The purpose of this was that no one in the age group would avoid or postpone a healthcare visit. But that risk seems to have been insignificant according to new research from the Sahlgrenska Academy.
— Some postpone their healthcare visits for a few months as they approach their 85th birthday for up to four months. But we cannot see that it has any negative effects on health, says Naimi Johansson, health economist in Region Örebro County and one of the researchers behind the study.
Went to the doctor
The researchers have gone through register data from Region Stockholm and the Västra Götaland region between the years 2014 and 2018. In total, information on 42,773 individuals has been compiled and the results have been published in the journal Journal of Health Economics.
The visits that were postponed until after the 85th birthday were mainly visits to nurses, physiotherapists or other healthcare personnel who were not doctors. The patients still made doctor’s visits or visits related to new ailments. However, there was a certain delay in planned visits.
— This indicates that the age group knows when they need to seek care and when they can wait. So they don’t seem to postpone more serious or urgent care visits because of the costs, says Naimi Johansson.
More expensive for the Stockholm region
A difference between the two regions that surprised the researchers was that in Västra Götaland the patients canceled visits to the nurse that fell just before their 85th birthday without making up for them afterwards. In Region Stockholm, the canceled nurse visits were replaced by doctor visits after the birthday.
The consequence was that in the Västra Götaland region the costs decreased by approximately SEK 265,000 per year, while in the Stockholm Region they increased by approximately SEK 501,000 per year. The researchers do not know why this is so, but Naimi Johannson points to differences in how the health centers are reimbursed for patient visits.
— During this period, compensation in Västra Götaland was linked to how many patients were listed at the health center, while in Stockholm it was also regulated by the number of visits. It is easy to believe that the care provider in Stockholm was more inclined to book a visit after the 85th birthday because it led to compensation.
“The study shows that a change in policy decisions can have different consequences than those the decision maker intended,” she says.
The research study is a collaboration between Gothenburg University, Region Örebro County and Örebro University, as well as Monash University, Australia.
“We have discussed in the research group that in other healthcare systems where healthcare visits are significantly more expensive, perhaps an age limit would cause even more urgent visits to be postponed for a longer period of time with negative consequences for the individual’s health as a result,” she says.