Reducing socioeconomic health inequalities is a key goal of most health systems. A challenge in this regard is that healthcare providers may have incentives to avoid or undertreat patients who are relatively costly to treat. Due to the socioeconomic gradient in health, individuals with low socioeconomic status (SES) are especially likely to be negatively affected by such attempts. To counter these incentives, payments are often risk adjusted based on patient characteristics. However, empirical evidence is lacking on how, or if, risk adjustment affects care utilization. We examine if a novel risk adjustment model in primary care affected socioeconomic differences in care utilization among individuals with a chronic condition. The new risk adjustment model implied that the capitation—the monthly reimbursement paid by the health authority to care providers for each enrolled patient—increased substantially for chronically ill low‐SES patients. Yet, we do not find any robust evidence that their access to primary care improved relative to patients with high SES, and we find no effects on adverse health events (hospitalizations). These results suggest that the new risk adjustment model did not reduce existing health inequalities, indicating the need for more targeted incentives and interventions to reach low‐SES groups.

中文翻译：

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通过风险调整变得更好？支付改革后瑞典护理利用的社会经济差异

减少社会经济健康不平等是大多数卫生系统的一个关键目标。这方面的一个挑战是，医疗保健提供者可能有动机避免治疗或治疗费用相对较高的患者。由于健康方面的社会经济梯度，社会经济地位（SES）较低的个人特别有可能受到此类尝试的负面影响。为了应对这些激励措施，付款通常会根据患者特征进行风险调整。然而，缺乏关于风险调整如何或是否影响护理利用的经验证据。我们研究初级保健中的一种新的风险调整模型是否影响慢性病患者护理利用的社会经济差异。新的风险调整模型意味着，对于慢性病低社会经济地位患者，按人头付费（卫生当局每月向每位登记患者的护理提供者支付的报销费用）大幅增加。然而，我们没有发现任何有力的证据表明他们获得初级保健的机会相对于高社会经济地位的患者有所改善，而且我们发现对不良健康事件（住院）没有影响。这些结果表明，新的风险调整模型并没有减少现有的健康不平等，这表明需要更有针对性的激励措施和干预措施来惠及低社会经济地位群体。