Sc04.01 Quality Matters - Should We Have Private Or Public Services In Primary Care?

S. Varilo1, K. Winell2, K. Winell2;
1Attendo MedOne, Helsinki, Finland, 2Conmedic, Helsinki, Finland.
Susanna Varilo
Attendo MedOne
Zip: 06100
Phone: +358405744868
Background: Municipalities are responsible for organizing health care in Finland. Most municipalities run a local health centre, but some outsource the services to private companies, mainly because of difficulties in recruiting Gps.
Attendo MedOne (AM) has produced outsourced primary care in Finland since 2004. The nationwide goal of AM is to enhance primary prevention and care of cardiovascular diseases. The implementation tool has been local process descriptions on coronary heart disease (CHD), type 2 diabetes (T2D), hypertension (BP), dyslipidaemia, asthma and smoking cessation. For quality improvement all the AM health centres participate in the Finnish Quality Network (FQN) which is a network that has focused on systematic improvement in the care of cardiovascular diseases since 1994. A common debate in Finland concerns the quality of care in outsourced vs. public health centres. In this study we hypothesized that outsourcing does not lead to lower quality.
Methods: We compared the results of all emerging AM centres (n=7) to all emerging public centres (n=138) joining the FQN during 2005-2008. The follow up measurement took place 3 years later. We measured the change in the proportion of patients reaching the indicator level of good care and run statistical analyses between private and public centres. The indicators were: proportion of T2D and CHD patients with LDL-cholesterol ?2.6mmol/l, proportion of T2D patients with HbA1c Results:There were no statistical significant differences in the indicators between the AM and public centres: LDL-cholesterol ? 2.6mmol/l among CHD patients 1.0%-point (95%CI -6.6-8.7) reduction vs. 3.2%-point (95%CI 1.4-5.0) and among T2D patients 6.8%-point (95%CI -0.8-14.5) vs. 3.7%-point (95%CI 2.1-5.2) reduction, HbA1c Conclusion: Our main hypothesis hold: Outsourcing health centres did not lead to lower quality of care in chronic diseases. Most of the indicators improved in both types of centres, the private improved best in reaching the LDL-cholesterol levels and the public in the HbA1c levels.
Quality matters - should we have private or public services in primary care?