Practice variation in Swedish primary care

Objective - To study individual practice patterns of physicians working in primary health care for standardized simulated cases on their first 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 procedures, drugs, follow-up appointments and sick pay. Setting - Swedish primary health care centres. Subjects - Two hundred randomly selected physicians. Main outcome measures - Activities taken by the physician diagnostic and laboratory tests ordered, drugs prescribed, length of sick leave and the cost of these actions. Results - Practice patterns varied considerably, corresponding to a six-fold difference in total cost between the ''cheapest'' and ''most expensive'' physician. The largest share was loss of pro duction as estimated by the cost of prescribed sick leave. Physicians who practised further away from hospitals and those who had worked more years tended to prescribe more measures. However, this only explained a small portion of the observed variation, which may be due to different physician attitudes to taking risks. Conclusion - ''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 first visits.