1. Primary care in Region Västra Götaland an example from Sweden Daniel Pollack General practitioner Senior medical advisor, Region Västra Götaland Sweden

2. Västra Götaland 49 local communities Population: 1,5 miljoner Inhabitants/km 2 : 63 Distance north-south: 300 km Distance east-west: 250 km

3. Hospitals: 17 (one is a University hospital the others are grouped in four divisions) Primary Care: 205 Health Centers (87 are private ) Region Västra Götaland

4. National primary care reform in Sweden Free patient choice of primary care Centres that qualify are free to open primary care centres To be handled by local counties = 21 different solutions

5. Primary care reform in Västra Götaland Start October 2009 141  206 centres Unchanged budget 7 500 inhabitants per centre

6. Primary Care in Region Västra Götaland Assignment Compensation Follow up Start in october 2009 Competion based on quality 205 units, 62 new

7. Assignment Broad task on ”primary care-level” Follow National and Regional medical guidelines Co-operation (internal and external) Education, training and research & development WHAT but not HOW

8. Based on: Age, gender and wardweight ( ACG ). 85 % P4P (reaching medical goals ) 4 % Geografic factors and socioeconomic conditions Special tasks Focus on quality – not quantity Compensation

9. Follow up 1 141 quality indicators. Most of them are directly picked up from electronic patient records 41 quality indicators related to compensation (4,2 %) Medical audit

10. Follow up 2 Aims of follow up programme Management information Provide information to primary care centers Pay for performance Public information for choice of center Medical audit