PRACTICE VARIATION IN SWEDISH PRIMARY-CARE

Objective - To study individual practice patterns of physicians workin g in primary health care for standardized simulated cases on their fir st visit, and relate them to resource consumption for diagnostic tests , drugs and sick leave from a combined perspective of the health care and social security systems. Design - Postal questionnaire presenting six hypothetical working-age cases with symptoms of ailments common in primary care asking physicians to order diagnostic tests and procedur es, drugs, follow-up appointments and sick pay. Setting - Swedish prim ary health care centres. Subjects - Two hundred randomly selected phys icians. Main outcome measures - Activities taken by the physician diag nostic and laboratory tests ordered, drugs prescribed, length of sick leave and the cost of these actions. Results - Practice patterns varie d considerably, corresponding to a six-fold difference in total cost b etween the ''cheapest'' and ''most expensive'' physician. The largest share was loss of pro duction as estimated by the cost of prescribed s ick leave. Physicians who practised further away from hospitals and th ose who had worked more years tended to prescribe more measures. Howev er, this only explained a small portion of the observed variation, whi ch may be due to different physician attitudes to taking risks. Conclu sion - ''Paper'' cases of common medical ailments presented to primary care physicians revealed considerable differences in practice style, resulting in six-fold differences in cost of measures prescribed at fi rst visits.