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Information and user choice in primary health care markets
Last registered on June 26, 2018

Pre-Trial

Trial Information
General Information
Title
Information and user choice in primary health care markets
RCT ID
AEARCTR-0000659
Initial registration date
May 08, 2015
Last updated
June 26, 2018 8:14 AM EDT
Location(s)
Region
Primary Investigator
Affiliation
University of Gothenburg
Other Primary Investigator(s)
PI Affiliation
Lund University
PI Affiliation
SFI - The Danish National Centre for Social Research
PI Affiliation
Lund University
Additional Trial Information
Status
Completed
Start date
2015-02-04
End date
2017-08-31
Secondary IDs
Abstract
In order to increase quality of care, all regions in Sweden have during the last decade implemented systems where users can choose their primary health care provider, and where there is freedom of establishment for providers. All primary health care units are financed by public means and pre-set user fees, but may be privately or publicly run. For user choice systems to improve the functioning of health care, users must choose health care units that deliver care of relatively high-quality. Previous studies indicate that a very large share of users in Sweden do not compare the quality of providers before making their choice of provider. The transaction costs related to information retrieval and switching present a possible obstacle to the functioning of this market: the gathering of information about and comparison of providers is costly in terms of time, and there are also (small) process costs related to notifying providers of the change. In this study, we provide three randomly drawn samples of the population in the region of Skåne with information about the quality of primary care providers, to see whether this freely available information affects their propensity to change provider, and the type of provider they choose. The first sample is representative of the whole population in the region (above 18 years of age), the second consists of individuals that have recently moved to the region, and the third sample consists of families that are expecting children. We also examine if lowering the process costs on top of providing free information affects the choice frequency, and whether the effects differ for groups defined by for example socioeconomic background and health status.
External Link(s)
Registration Citation
Citation
Anell, Anders et al. 2018. "Information and user choice in primary health care markets." AEA RCT Registry. June 26. https://doi.org/10.1257/rct.659-3.0.
Former Citation
Anell, Anders et al. 2018. "Information and user choice in primary health care markets." AEA RCT Registry. June 26. http://www.socialscienceregistry.org/trials/659/history/31197.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
There are three parts to the experiments:

Part 1: In this part, the regional health authority in the region of Skåne (located in the south-west of Sweden) - Region Skåne - provides 1 percent of the population that are over 18 years old with information about the primary care center that they are listed at and its three geographically nearest competitors. The information is sent by mail, and contains information about, among other things, opening hours, quality ratings, and special competences. Within the 1 percent group, there are two treatments: one group receives only information about primary care centers (T1), the other receives this information along with a pre-paid form that notifies the new and old provider about the change (T2).

Part 2: The procedure for this part is similar to the one described for Part 1, it is basically only the target group that differs. In Part 3, information will be sent specifically to individuals who have recently moved to Skåne. There may be such individuals also in the sample for Part 1, but they are a very small subset.
Intervention Start Date
2015-02-24
Intervention End Date
2015-09-01
Primary Outcomes
Primary Outcomes (end points)
The outcome variables of main interest are the frequency of choice, and the type of primary care providers chosen by users in our samples.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The premise for Part 1 is that the regional health authority has to treat all primary care centers equally, in order to be neutral in terms of competition on this market. Using the random number generator within Stata (which we use for all randomizations), we therefore first draw 11 percent of listed individuals over 18 from each of the 150 primary care centers. Then, we randomly select 9.0909091 percent of these 11 percent, which constitute the treatment group. In total, this procedure implies that 1 percent of the total population over 18 will be treated. The remaining 10 percent constitutes the control group. Among the treatment group, we then randomly assign 25 percent to the group that only receives information (T1), and 75 percent to the group that receives information and a pre-paid change form (T2).

Several details about how we will conduct the randomization for Part 2 and 3 are presently not known. We will use a cluster randomized trial for Part 3, but a detailed description of the procedure will have to be added at a later date.
Experimental Design Details
Randomization Method
Part 1: Using the random number generator within Stata (which we use for all randomizations), we therefore first draw 11 percent of listed individuals over 18 from each of the 150 primary care centers. Then, we randomly select 9.0909091 percent of these 11 percent, which constitute the treatment group. In total, this procedure implies that 1 percent of the total population over 18 will be treated.
Randomization Unit
The unit of randomization is for Part 1 individuals, Part 2 is address (i.e., household) (or potentially postal code) and Part 3 antenatal care centers, and Part 3 individuals.
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
Part 2: Number of addresses/households in the sample is currently unknown (postal codes >2000) Part 3: 80 antenatal care centers.
Sample size: planned number of observations
Part 1: Total sample is 112 861 individuals. Part 2 and Part 3: to be added.
Sample size (or number of clusters) by treatment arms
Part 1: T1 = 2,559, T2 = 7,700, and the control group = 102,602. Part 2 and Part 3: to be added.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Regionala Etikprövningsnämnden Lund
IRB Approval Date
2014-06-11
IRB Approval Number
Dnr 2014/49
Analysis Plan
Analysis Plan Documents
Analysis_plan

MD5: 54a615bf41fa52a109c55652f0697164

SHA1: 4c6aeda273807f532fdee0758395dae7ecf097b1

Uploaded At: May 08, 2015

Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is data collection complete?
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports, Papers & Other Materials
Relevant Paper(s)
REPORTS & OTHER MATERIALS