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Swedish citizens' opinions on decision support in primary healthcare

Published Online:pp 151-170

Choice reform in public healthcare includes the expectation that citizens will choose a healthcare provider. This paper investigates the informational support they need in order to choose a primary healthcare provider. The study is based on an electronic survey (n = 990) in Sweden. The Callon and Muniesa model is used as the paper's theoretical framework. This model, which describes the sequential phases of isolating alternatives, examining alternatives and ranking and making choices, emphasises that technological devices support consumer choice. The paper concludes that public healthcare web portals and information leaflets are more popular platforms than private healthcare web portals and social networks. The data citizens find most useful for examining alternatives are waiting times, doctors' competences and reception. The paper makes suggestions for the design of technological devices citizens can use to choose healthcare providers. The theoretical framework shows the technological and political character of information used to support choice.


primary care, choice, e-government, consumerism, information, decision support, healthcare, the web, e-health


  • 1. , Anttiroiko, A-V.Mälkiä, M.Anttiroiko, A.V.Savolainen, R. (2004).‘Introduction to democratic e-governance’.E-transformation in Governance: New Directions in Government Politics.Hershey, PA:, Idea Group22-49 Google Scholar
  • 2. Archer, M., Tritter, J. (2000).Rational Choice Theory. Resisting Colonization.London and New York:Routledge Google Scholar
  • 3. , Bendz, A.Nilsson, L. (2011).‘Choice in healthcare – views from the west coast in Sweden about choice in primary care’ [Att välja vård – Västsvenskarnas och vårdvalet].West-Swedish Democracy in Our Time [Västsvensk demokrati i tid och rum. SOM-institutet].Sweden:University of Gothenburg Google Scholar
  • 4. , Callon, M.Callon, M. (1998).‘The embeddedness of economic markets in economics’.The Laws of the Market.Oxford:, Blackwell Publishers1-57 Google Scholar
  • 5. Callon, M., Muniesa, F. (2005).‘Economic markets as calculative collective devices’.Organization Studies.26,8,1229-1250 Google Scholar
  • 6. Callon, M., Millo, Y., Muniesa, F. (2007).Market Devices.Oxford:Blackwell Publishers Google Scholar
  • 7. Centre for E-health in Sweden (2010).Project Description. Healthcare on the Web. Round 4. Development and Implementation of [Projektbeskrivning. Vården på webben. Etapp 4. Utveckling och leverans av].Stockholm:Centre for E-health in Sweden Google Scholar
  • 8. Clarke, J.‘Beyond citizens and consumers? Publics and public service reform’.NISPA Journal of Public Administration and Policy., 2009–2010, Winter, 2009–20102,2, doi: 10.2478/v10110-009-0003-z Google Scholar
  • 9. Coulter, A. (2010).‘Do patients want a choice and does it work?’.British Medical Journal.241,973-975 Google Scholar
  • 10. Dahlberg, S., Lundmark, S., Martinsson, J.‘How representative is a self-selected web-panel? – The effect on representation of different sampling procedures and survey modes’., 2012, 17–20 May, 2012Paper presented at the American Association for Public Opinion Research (AAPOR) ConferenceOrlando Google Scholar
  • 11. Damman, O. (2010).Public Reporting about Healthcare Users' Experiences: The Consumer Quality Index.Dissertation, NIVEL, Utrecht Google Scholar
  • 12. Department of HealthReport of the National Patient Survey, England., 2009August, 2009Department of Health, London Google Scholar
  • 13. , Engström, A., Wallström, Å., Salehi-Sangari, E.Lindblad-Gidlund, K.Ekelin, A.Eriksén, S.Ranerup, A. (2010).‘E-Government from a citizen's perspective – the underused capacity of market orientation' [E-government ur medborgarnas perspektiv – marknadsorienteringens outnyttjade möjligheter]’.Changes in Government and Citizenship [Förvaltning och medborgarskap i förändring]., Studentlitteratur, Lund101-118 Google Scholar
  • 14. Faber, M., Bosch, M., Wollersheim, H., Leatherman, S., Grol, R. (2009).‘Public reporting in healthcare: How do consumers use quality-in-care information? A systematic review’.Medical Care.47,1-8 Google Scholar
  • 15. Fanjiang, G., von Glahn, T., Chang, H., Rogers, W., Safran, D. (2007).‘Providing patients' web-based data to inform physician choice: If you build it, will they come?’.Journal of General Internal Medicine.2,1463-1466 Google Scholar
  • 16. Fasolo, B., Reutskaja, E., Dixon, A., Boyce, T. (2010).‘Helping patients choose: How to improve the design of comparative scorecards of hospital quality’.Patient Education & Counseling.78,344-349 Google Scholar
  • 17. Fotaki, M., Roland, M., Boyd, A., McDonald, R., Scheaff, R., Smith, L. (2008).‘What benefits will choice bring to patients? Literature review and assessment of implications’.Journal of Health Services Research & Policy.13,3,178-184 Google Scholar
  • 18. Gauld, R., Goldfinch, S., Horsburgh, S. (2010).‘Do they want it? Do they use it? The ‘Demand-Side’ of e-government in Australia and New Zealand’.Government Information Quarterly.27,177-186 Google Scholar
  • 19. Glenngård, A., Anell, A., Beckman, A. (2011).‘Choice of primary care provider: results from a population survey in three Swedish counties’.Health Policy.103,1,31-37 Google Scholar
  • 20. Green, J., McDowell, Z., Potts, H. (2008).‘Does Choose & Book fail to deliver the expected choice to patients? A survey of patients' experience of outpatient appointment booking’.BMC Medical Informatics & Decision Making.8,36, doi:10.1186/1472-6947-8-36 Google Scholar
  • 21. Greener, I. (2007).‘Are the assumptions underlying patients choice realistic? A review of the evidence’.British Medical Bulletin.83,1,249-258 Google Scholar
  • 22. Hawn, C. (2009).‘Take two aspirin and tweet me in the morning: How Twitter, Facebook and other social media are reshaping healthcare’.Health Affairs.28,2,361-368 Google Scholar
  • 23. Institute for Quality Indicators (2010).National Patient Survey in Primary Healthcare 2010 [Nationell patientenkät Primärvård 2010].Institute for Quality Indicators Google Scholar
  • 24. Josefsson, U., Ranerup, A. (2003).‘Consumerism revisited. The emergent roles of new electronic intermediaries between citizens and the public sector’.Information Polity.8,3–4,167-180 Google Scholar
  • 25. Le Grand, J. (2007).The Other Invisible Hand: Delivering Public Services through Choice and Competition.Princeton, NJ:Princeton University Press Google Scholar
  • 26. Lee, G., Kwak, Y.H. (2012).‘An open government maturity model for social media-based public engagement’.Government Information Quarterly.29,492-503 Google Scholar
  • 27. , Lips, A.M.B.Nixon, P.G.Koutrakou, V.N.Rawal, R. (2007).‘E-government under construction: challenging traditional conceptions of citizenship’.Understanding E-Government in Europe. Issues and Challenges.London and New York:, Routledge33-47 Google Scholar
  • 28. MacKenzie, D. (2009).Material Markets. How Economic Agents Are Constructed.Oxford:Oxford University Press Google Scholar
  • 29. McFall, L. (2009).‘Devices and desires: How useful is the ‘new’ economic sociology for understanding market attachment’.Sociology Compass.3,2,267-282 Google Scholar
  • 30. Ministry of Health and Social Affairs (2008–2009).Government Bill 2008/2009:74. Choice in Primary Healthcare [Regeringens proposition 2008/2009:74 Vårdval i primärvården].Stockholm:Ministry of Health and Social Affairs Google Scholar
  • 31. Ministry of Health and Social Affairs (2009).Law about Choice [LOV att välja. Lag Om Valfrihetssystem].Stockholm:SOU 2008:15, Ministry of Health and Social Affairs Google Scholar
  • 32. Moser, A., Korstjens, I., van der Weijden, T., Tange, H. (2010).‘Themes affecting healthcare consumers' choice of a hospital for elective surgery when receiving web-based comparative consumer information’.Patient Education & Counseling.78,365-371 Google Scholar
  • 33. Newman, J., Clarke, J. (2009).Publics, Politics & Power. Remaking the Public in Public Services.UK:SAGE Google Scholar
  • 34. Nordgren, L., Ahgren, B. (2011).Choice in Primary Care: The Result of a User Investigation Based on Group Interviews [Val av primärvård:resultat från en brukarundersökning baserad på invånarpaneler].Konkurrensverket, Stockholm Google Scholar
  • 35. Ranerup, A. (2010).‘Transforming patients to consumers. Evaluating national healthcare portals’.International Journal of Healthcare Management.23,331-339 Google Scholar
  • 36. Ranerup, A., Norén, L., Sparud-Lundin, C. (2012).‘Decision support systems for choosing a primary healthcare provider in Sweden’.Patient Education and Counseling.86,3,342-347 Google Scholar
  • 37. , Schneider, A.Levin, H.M. (2001).‘Information and choice in educational privatization’.Privatizing Education. Can the Marketplace Deliver Choice, Efficiency, Equity, and Social Cohesion?.Cambridge, MA:, Westview Press72-102 Google Scholar
  • 38. Scholl, H.J., Barzilai-Nahon, K., Ahn, J-H., Popova, O.H., Re, B.‘E-commerce and e-government: How do they compare’., 2009, 5–8 JanuaryProceedings of the 42nd Hawaii International Conference on System Sciences, IEEEBig Island, Hawaii Google Scholar
  • 39. Srivastava, S., Teo, T.S.H. (2011).‘Development and impact of e-government: the intertwined role of e-commerce from a cross-country stakeholder's perspective’.Electronic Government, An International Journal.8,2–3,144-163 AbstractGoogle Scholar
  • 40. Wun, Y.T., Lam, T.P., Lam, K.F., Li, D., Yip, K.C. (2010).‘How do patients choose their doctors for primary care in a free market?’.Journal of Evaluation in Clinical Practice.16,1215-1220 Google Scholar
  • 41. Zinner Henriksen, H. (2006).‘Fad or investment in the future: an analysis of the demand of e-services in Danish municipalities’.The Electronic Journal of E-Government.4,1,19-26 Google Scholar