Exploring Demand-Side Drivers of Regional Variations in Outpatient Care Utilization in Sweden

Abstract

Introduction: Regional variations in healthcare utilization are well documented across different healthcare services, shaped by differences in population health, socioeconomic conditions, and healthcare system structures. In Sweden, outpatient care utilization continues to vary across regions, raising important question about healthcare equity and distribution of healthcare resources. Although the influence of demand and supply-side factors is debated on, a substantial share of this variation remains unexplained. Aim: To investigate the demand-side factors contributing to regional variations in outpatient primary and specialist care in Sweden from 2018 to 2023, using Andersen's Behavioral Model as a guiding framework. Methods: This study employed a quantitative, longitudinal panel design to analyse regional level data from Sweden’s 21 administrative regions. Hierarchical random effect model was used to assess the incremental contribution of predisposing, enabling and need based factors and their associations with outpatient care utilization. Results: Primary care visits were strongly associated with demographic and socioeconomic factors, with the final model explaining 61.5% of the between region variation. In contrast, specialist care showed an inverse relationship with health need, as regions with poorer self-rated health and greater financial hardships reported lower use of specialist services with the final model explaining only 37.7% of between region variances. Conclusion: Regional disparities in outpatient care utilization is driven by demographic and socioeconomic conditions for primary care visits and specialist care shows signs of unmet need among vulnerable populations. However, 62.3% and 38.5% of the regional variation remain unexplained for specialist care and primary care respectively, indicating omitted and unobserved factors that could contribute substantially to regional variation. Future studied should incorporate supple-side factors to better capture the drivers of outpatient care utilization.