Cream skimming i Region Stockholms primärvård? : En spatial analys av privata och offentliga vårdcentralersetableringsmönster på DeSO-nivå

Sammanfattning

This study examines whether private primary care providers in Region Stockholm engage in geographic cream skimming, locating in socioeconomically advantaged areas where reimbursement exceeds expected care costs. Using logistic regression on all 243 centers under Vårdval Stockholm, geocoded to DeSO (demographic statistical area) level, four nested models test whether private operation correlates with socioeconomic indicators after geographic controls. The results offer limited aggregate support: only the share of residents aged 65 and older remains a significant negative predictor, while other socioeconomic coefficients are insignificant. This sparse pattern is consistent with the 2017 ACG based risk adjustment having reduced incentives for area level selection, leaving demographic care burden as the least fully compensated dimension. A within sector analysis tentatively associates chain ownership with lower educational shares, and an exploratory spatial analysis suggests private providers locate in low rental pockets bordered by high rental neighbors. Both secondary findings are sensitive to specification.