Access to choice‑enabled healthcare providers among children and adults with intellectual disabilities in comparison with the general population (IDcare)

Access to choice‑enabled healthcare providers among children and adults with intellectual disabilities in comparison with the general population (IDcare) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Access to choice‑enabled healthcare providers among children and adults with intellectual disabilities in comparison with the general population (IDcare) Anna Axmon, Karin Engström, Magnus Sandberg This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9263449/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background People with intellectual disabilities often have complex healthcare needs and may therefore experience different patterns of healthcare utilization within such systems. This study examined the overlap between the use of public and private healthcare providers as an indicator of access to choice-enabled healthcare providers within a patient-choice-based health system. Methods We assessed overlap in two complementary ways: among people with at least one private healthcare contact and among those with at least one public healthcare contact in a cohort of people with intellectual disability (ID cohort) and a referent cohort from the general population (gPop cohort). The ID cohort comprised 2 813 children and 9 079 adults, whereas the gPop cohort comprised 146 048 children and 982 186 adults. Data regarding healthcare contacts in public and privately organized healthcare were collected from the Skåne Healthcare Register. Results Among those with at least one contact in privately organized healthcare, both children and adults with intellectual disabilities were as likely as those in the general population to also have contacts in public primary healthcare and public somatic specialist care. However, they were more likely to have contacts in public psychiatric specialist care. Among those with at least one contact in public healthcare, children with intellectual disabilities were as likely as their age peers in the general population to also have contacts in privately organized healthcare. However, adults with intellectual disabilities were less likely than their age peers to have contacts in privately organized healthcare. Conclusions These findings have important implications for patient‑choice‑based health systems. They indicate that formally available provider choice does not result in similar patterns of utilisation across populations. Also, that adults with intellectual disabilities may face challenges in navigating and using privately organised providers within such systems. The prominent role of public psychiatric specialist services further highlights the continued importance of publicly provided specialist care for this group. Together, the results underscore the need for patient‑choice‑based healthcare systems to be designed and implemented in ways that support accessibility, coordination, and navigation for people with intellectual disabilities, particularly adults with complex healthcare needs and during periods of healthcare disruption. Patient involvement private healthcare providers intellectual disability register study primary healthcare specialist care health services accessibility Background In a healthcare systems, one policy approach intended to strengthen patient’s influence over their healthcare is the introduction of patient choice systems, in which people are free to choose between different healthcare providers. During the early 2000s, several European countries introduced such systems, allowing people to choose between public and private healthcare providers within a patient-choice-based health system, with the aim of increasing patients’ influence over their care and improving healthcare quality through competition ( 1 – 3 ). These reforms can be conceptually linked to the broader shift towards person-centred care, which emphasises responsiveness to patients’ needs and preferences ( 4 , 5 ). In healthcare systems that formally allow patients to choose between public and private healthcare providers, the use of more than one type of provider can be viewed as an indicator of realised use of the available choice options within the system. However, evidence of consistent positive effects is limited, including for waiting times ( 6 – 8 ), number of visits ( 6 ), mortality ( 8 – 10 ), hospital length of stay ( 8 – 10 ), and hospital readmissions ( 8 – 10 ). Instead, the introduction of free choice of care has been associated with increased inequities ( 11 – 14 ) and may also complicate the delivery of integrated care ( 15 , 16 ). Intellectual disability is a condition that is present from early life and diagnosed before the age of 18 years, characterized by limited cognitive ability and understanding. People with intellectual disabilities are known to have poorer somatic ( 17 ) and mental ( 18 ) health than the general population, and they often have complex healthcare needs. As a result, people with intellectual disabilities may be particularly vulnerable in healthcare systems that rely on patients’ ability to navigate available options and actively choose between providers. This concern is supported by studies showing that people with intellectual disabilities experience barriers in shared decision-making ( 19 – 21 ), despite expressing a desire to be involved in decisions regarding their own healthcare ( 22 , 23 ) and evidence that supported decision-making can be successfully implemented in some contexts ( 24 – 26 ), particularly when appropriate support is provided ( 22 , 27 , 28 ), and research showing that self-determination is associated with mental health ( 29 , 30 ), quality of life ( 31 ), and life satisfaction ( 32 ). Little is known about how people with intellectual disabilities utilise patient choice options within healthcare systems that formally offer free choice of provider. In studies of healthcare choice, it is important to consider that for children – both with and without disabilities – seeking healthcare relies more on the parent than on the child. Therefore, there may be different processes in the choice of healthcare providers for children and adults. Such differences can be identified only by assessing children and adults separately. The COVID-19 pandemic had a major impact on healthcare services. In Sweden, the high demand put on the healthcare system resulted in, e.g., a decrease in surgeries and somatic inpatient care and fewer contacts with physicians in specialist outpatient care ( 33 ). Although previous studies have not found clear evidence of discrimination against children (unpublished results) or older people ( 34 ) with intellectual disabilities, studies on healthcare utilization need to consider differences in healthcare delivery between the pre-pandemic and pandemic periods. Methods This register-based study uses national and regional registers to both identify the study population and collect outcome data. We operationalised access to choice-enabled providers as observed utilisation across provider types, which reflects realised use of available options rather than the availability of choice per se or people’ ability to actively choose providers. Thus, the aim of the present study was to assess the overlap between the use of public and private healthcare providers as an indicator of access to choice-enabled healthcare providers within a patient-choice-based health system among children and adults with intellectual disabilities in comparison to the general population during pre-pandemic (2014–2019) and pandemic periods (2020–2021). Setting This study is set in Skåne (Scania), the southernmost region of Sweden. In September of 2025, the population of Skåne was approximately 1.4 million, which corresponds to approximately 13% of the Swedish population. The administrative unit for Skåne, i.e., the county council, is called Region Skåne. Swedish healthcare is part of the welfare system and is financed mainly by taxes. Patients pay only a small fee, which may vary across counties. In Skåne, the number of consultations with physicians in primary healthcare and outpatient specialist care is 200 SEK (approximately €17, conversion made November 24, 2025)( 35 ). In all of Sweden, there is a yearly cap of 1450 SEK ( 36 ), corresponding to approximately €122. Thus, a patient would never pay more than this amount over a 12-month period. Basic healthcare is provided in primary healthcare. These may be either public or privately organized. Healthcare requiring specialized care is provided at hospitals or by private healthcare providers. The fee is the same in public healthcare and in privately organized healthcare, provided that the private healthcare provider is under contract with the county council. According to the Swedish Act on System of Choice in the Public Sector ( 37 ), which was introduced in 2009, patients are free to choose their own healthcare provider in both primary and specialist care. This legislation establishes a formal patient-choice-based healthcare system, in which patients may choose between publicly and privately operated providers included in the regional healthcare system. Consequently, privately organized healthcare within the regional system represents access to alternative, choice-enabled healthcare providers rather than privately financed care. The availability of private healthcare providers varies between types of care. For example, approximately 50% of all physical contacts in primary healthcare are to private healthcare providers, but most of these are not to physicians but to physiotherapists and occupational therapists ( 38 ). In both somatic and psychiatric specialist care, approximately 20% of healthcare contacts are private healthcare providers, the majority of which are in an open care setting. However, most hospitals are owned and operated by regions ( 39 ). Approximately 86% of all expenditures on healthcare are public expenditures ( 40 ), suggesting that healthcare contacts with private healthcare providers not under contract with county councils are limited. According to the Swedish Act Concerning Support and Service for Persons with Certain Functional Impairments (the LSS law), people with intellectual disability and/or autism spectrum disorder are entitled to the service and support they need to live fulfilling lives. These services and support include, e.g., daily activities, housing, and personal assistance but not financial aid. The services and support are provided by the municipality after application from the individual or their care takers, followed by a need assessment. As a rule, support according to the LSS act is free of charge, but the municipality may charge for costs associated with supported living (mainly rent) and for leisure time and cultural activities. Data sources The Skåne Healthcare Register comprises data on all public healthcare and healthcare provided by private healthcare providers under contract with Region Skåne. Each record includes the date of the healthcare contact, which healthcare area (e.g., primary healthcare or somatic specialist care) the contact was recorded in, the profession of the treating person, and the type of contact (e.g., in person or phone) as well as information on the patient, such as sex and age. Moreover, records from public healthcare comprise both primary and secondary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The LSS register at the Swedish National Board of Health and Welfare includes data on all services and support provided according to the LSS law. Although a diagnosis of intellectual disability or autism spectrum disorder is required to be eligible for LSS support, diagnoses are not recorded in the LSS register. Study populations This study is based on the IDcare study ( 41 ). In IDcare, we included all people living in Skåne on January 1st, 2014. People with at least one measure of service and support according to the LSS act from 2007 to 2021 and/or people with at least one diagnosis of intellectual disability (F70–F79 in the ICD-10) or Down syndrome (Q90) from 2014 to 2021 were included in the ID cohort (n = 14 716; 5 939 women and 8 777 men). As people living with a person with intellectual disabilities may differ from people not living with such a person regarding health and healthcare utilization, we excluded those who were not in the ID cohort but in the same family or household as a person in the ID cohort (n = 31 688). The remaining population of Skåne comprised the general population reference cohort (gPop cohort, n = 1 226 955; 620 032 women and 606 923 men). For the present study, we identified those who were either children (i.e., 18 years old, corresponding to being born before 1996) during the entire study period, excluding those aged 18 years from 2014 to 2021. If not otherwise implied, the terms men and women will henceforth be used to describe the adult population by sex and boys and girls to describe the children by sex. Healthcare utilization Data regarding healthcare utilization were collected from the Skåne Healthcare Register. We selected all physical contacts (i.e., excluding phone and video consultations) with physicians if they were recorded in healthcare areas public primary healthcare (henceforth referred to as primary healthcare ), privately organized healthcare for care providers under contract with Region Skåne ( private healthcare ), public psychiatric outpatient specialist care ( psychiatric healthcare ), or public somatic outpatient specialist care ( somatic healthcare ). For each healthcare area, we determined whether each person had at least one visit during the pre-pandemic (2014–2019) and pandemic (2020–2021) periods. Statistics We assessed the overlap between public and private healthcare utilization within the publicly funded healthcare system in two different ways. 1) Among people with at least one visit in private healthcare during each period (pre-pandemic and pandemic), we compared the number of people with at least one visit during the study period in each of the public healthcare areas in the ID cohort with that in the gPop cohort. 2) Among people with at least one visit in each public healthcare area during each period, we assessed the number of people with at least one visit during the study period in private healthcare. Comparisons of the ID cohort to the gPop cohort were performed using Poisson regression to estimate relative risks (RRs) with 95% confidence intervals (CIs). All analyses were stratified by age group (children and adults) and sex and adjusted for year of birth. The interaction between age group and cohort, i.e., whether the potential association between the ID cohort and the outcome differed between children and adults, was assessed via models including age group, cohort, and the cross-term between the age group and cohort. Similarly, the interaction between sex and cohort was assessed in models including sex, cohort, and the cross-term between sex and cohort, and the interaction between period and cohort was assessed in models including period, cohort, and the cross-term between period and cohort. All analyses were performed in IBM SPSS Statistics 30.0. p values less than 0.05 were considered statistically significant. To avoid the identification of single people as well as in consideration of statistical power, the results are presented only for groups comprising at least five people. Results Population characteristics The ID cohort comprised 2 813 children (1 864 boys and 949 girls) and 9 079 adults (5 154 men and 3 925 women), whereas the gPop cohort comprised 146 048 children (74 526 boys and 71 522 girls) and 982 186 adults (481 843 men and 500 343 women). The children in the ID cohort were slightly older than the children in the gPop cohort were (median year of birth 2008 vs 2009), whereas the opposite was observed among the adults (median year of birth 1981 vs 1965). Healthcare utilization The percentage of people with at least one contact in private healthcare ranged from 5% among boys and girls in the ID cohort during the pandemic period to 70% among women in the gPop cohort during the pre-pandemic period (Table 1 ). Among adults, there was a pattern of greater use among women than among men in both cohorts and during both periods. The percentage of people with at least one contact in any public healthcare was high in both cohorts, with almost 100% among children and adults in the ID cohort during the pre-pandemic period. The overlap between private and public healthcare utilization, i.e., the number of people with at least one contact in private healthcare as well as at least one contact in each type of public healthcare, is presented in Table 2 . Table 1 Number and percentage of people with at least one contact in each type of healthcare Period Healthcare area Sex Children Adults gPop ID gPop ID n % n % n % n % Pre-pandemic Private healthcare Men 15 205 20 394 21 149 446 31 1 023 20 Women 13 162 18 190 20 348 195 70 1 935 49 Any public healthcare Men 69 930 94 1 835 98 431 311 90 5 030 98 Women 66 633 93 939 99 473 009 95 3 852 98 Primary healthcare Men 66 516 89 1 668 89 406 190 84 4 807 93 Women 63 708 89 857 90 456 978 91 3 766 96 Psychiatric healthcare Men 4 530 6 870 47 31 528 7 2 190 42 Women 2 594 4 373 39 34 768 7 1 614 41 Somatic healthcare Men 54 630 73 1 645 88 346 628 72 3 813 74 Women 49 715 70 871 92 406 578 81 3 273 83 Pandemic Private healthcare Men 4 565 6 93 5 56 953 13 263 5 Women 4 467 6 46 5 242 028 52 1 096 30 Any public healthcare Men 47 566 64 1 489 80 313 686 70 4 112 86 Women 45 698 64 825 88 369 081 79 3 248 89 Primary healthcare Men 36 915 50 935 50 271 035 60 3 558 74 Women 37 085 52 567 60 331 008 71 2 935 81 Psychiatric healthcare Men 4 573 6 444 24 15 567 3 1 292 27 Women 3 978 6 221 23 17 028 4 970 27 Somatic healthcare Men 28 040 38 1 071 58 213 776 48 2 513 52 Women 25 884 36 629 67 263 436 57 2 235 61 ID = a cohort of people with intellectual disabilities, gPop = a referent cohort of people from the general population Any public healthcare vs private healthcare Among those with at least one contact in private healthcare, men and women in the ID cohort were 17% and 11%, respectively, more likely than those in the gPop cohort to have at least one contact in public healthcare during the pandemic period (Table 3 ; Supplement 1). Although the risk estimates were similar for adults and children, the risks for boys and girls did not achieve statistical significance. Moreover, there were no statistically significant sex, age, or period effects. Among those with at least one contact in public healthcare, both men and women in the ID cohort were less likely to have contact in private healthcare during both periods. The effect was more pronounced among men and during the pandemic period. For children, no difference in the risk of private healthcare was found between the cohorts for the pre-pandemic period, but during the pandemic period, both boys and girls in the ID cohort had a decreased risk of having at least one contact in private healthcare. Table 2 Overlap between public and private healthcare contacts Period Healthcare area Sex Children Adults gPop ID gPop ID n % pu % pr n % pu % pr n % pu % pr n % pu % pr Pre-pandemic Any public healthcare Men 14 886 21 98 391 21 99 145 375 34 97 1 013 20 99 Women 12 862 19 98 189 20 99 339 425 72 97 1 913 50 99 Primary healthcare Men 14 379 22 95 363 22 92 139 298 34 93 980 20 96 Women 12 438 20 94 182 21 96 330 255 72 95 1 886 50 97 Psychiatric healthcare Men 989 22 7 206 24 52 11 210 36 8 557 25 54 Women 589 23 4 83 22 44 24 245 70 7 898 56 46 Somatic healthcare Men 12 619 23 83 364 22 92 127 561 37 85 826 22 81 Women 10 682 21 81 180 21 95 296 546 73 85 1 676 51 87 Pandemic Any public healthcare Men 3 536 7 77 85 6 91 50 216 16 88 252 6 96 Women 3 573 8 80 44 5 96 209 878 57 87 1 029 32 94 Primary healthcare Men 2 820 8 62 57 6 61 44 771 17 79 233 7 89 Women 2 936 8 66 33 6 72 188 777 57 78 975 33 89 Psychiatric healthcare Men 309 7 7 29 7 31 2 049 13 4 88 7 33 Women 345 9 8 10 5 22 8 004 47 3 321 33 29 Somatic healthcare Men 2 284 8 50 62 6 67 38 453 18 68 202 8 77 Women 2 293 9 51 30 5 65 150 567 57 62 739 33 67 ID = a cohort of people with intellectual disabilities, gPop = a referent cohort of people from the general population, % pu = percentage with private healthcare of those with public healthcare, % pr = percentage with public healthcare of those with private healthcare Table 3 Any public healthcare among people with intellectual disabilities compared with the general population Children Adults Outcome Period Sex RR (95% CI) RR (95% CI) p (age) Any public healthcare among those with private healthcare Pre-pandemic Men 1.02 (0.92–1.12) 1.03 (0.97–1.10) 0.742 Women 1.02 (0.88–1.18) 1.02 (0.97–1.07) 0.987 p (sex) 0.965 0.838 Pandemic Men 1.17 (0.95–1.46) 1.17 ( 1.04 – 1.33 ) 0.989 Women 1.17 (0.87–1.58) 1.11 ( 1.05 – 1.18 ) 0.665 p (sex) 0.976 0.580 p (period) Men 0.208 0.356 Women 0.341 0.110 Private healthcare among those with any public healthcare Pre-pandemic Men 1.02 (0.92–1.13) 0.69 ( 0.65 – 0.73 ) < 0.001 Women 1.04 (0.90–1.21) 0.71 ( 0.68 – 0.74 ) < 0.001 p (sex) 0.619 < 0.001 Pandemic Men 0.77 ( 0.62 – 0.96 ) 0.47 ( 0.41 – 0.53 ) < 0.001 Women 0.68 ( 0.50 – 0.91 ) 0.55 ( 0.52 – 0.59 ) 0.166 p (sex) 0.525 < 0.001 p (period) Men 0.026 < 0.001 Women 0.012 < 0.001 Relative risks (RRs) with 95% confidence intervals (CIs) for any public healthcare among children and adults with intellectual disabilities compared with their age peers in the general population, with p values assessing risk differences between sexes [p (sex)], age groups [p (age)], and periods [p (period)]. Bold text indicates statistically significant results. Primary healthcare vs private healthcare Among those with at least one contact in private healthcare, there was a 26% increased risk for men and a 19% increased risk for women in the ID cohort to have at least one contact in primary healthcare during the pandemic period (Table 4 ; Supplement 1). For women, this risk was statistically significantly greater than that in the pre-pandemic period. No effects were found among boys and girls in the ID cohort, nor were there any other statistically significant age, sex, or period effects. Among those with at least one contact in primary healthcare, adults had a decreased risk of having at least one contact in private healthcare. The risk associated with the ID cohort was more pronounced among men and during the pandemic period. No effects were found for the children in the ID cohort. Table 4 Primary healthcare among people with intellectual disabilities compared with the general population Children Adults Outcome Period Sex RR (95% CI) RR (95% CI) p (age) Public primary healthcare among those with private healthcare Pre-pandemic Men 0.98 (0.88–1.09) 1.05 (0.99–1.12) 0.213 Women 1.02 (0.88–1.18) 1.03 (0.99–1.08) 0.794 p (sex) 0.671 0.874 Pandemic Men 0.99 (0.76–1.28) 1.26 ( 1.11 – 1.44 ) 0.099 Women 1.07 (0.76–1.50) 1.19 ( 1.12 – 1.27 ) 0.603 p (sex) 0.697 0.581 p (period) Men 0.886 0.209 Women 0.683 0.012 Private healthcare among those with public primary healthcare Pre-pandemic Men 1.02 (0.92–1.13) 0.68 ( 0.64 – 0.72 ) < 0.001 Women 1.09 (0.94–1.26) 0.71 ( 0.68 – 0.74 ) < 0.001 p (sex) 0.376 < 0.001 Pandemic Men 0.80 (0.62–1.04) 0.47 ( 0.42 – 0.54 ) 0.001 Women 0.73 (0.52–1.02) 0.57 ( 0.53 – 0.60 ) 0.143 p (sex) 0.706 < 0.001 p (period) Men 0.107 < 0.001 Women 0.040 < 0.001 Relative risks (RRs) with 95% confidence intervals (CIs) for primary healthcare among children and adults with intellectual disabilities compared with their age peers in the general population, with p values assessing risk differences between sexes [p (sex)], age groups [p (age)], and periods [p (period)]. Bold text indicates statistically significant results. Psychiatric healthcare vs private healthcare Among those with at least one contact in private healthcare, children and adults in the ID cohort were up to nine times more likely to have at least one contact in psychiatric healthcare (Table 5 ; Supplement 1). During the pre-pandemic period, the risk was greater among children than among adults, whereas the opposite was found during the pandemic period. Moreover, whereas the risk decreased over time for children, it increased for adults. Among those with at least one contact in psychiatric healthcare, adults had a decreased risk of having at least one contact in private healthcare. The effect was more pronounced during the pandemic period and among men. Among children, particularly girls, there was a decreased risk of having at least one contact in private healthcare during the pandemic but not during the pre-pandemic period. Table 5 Psychiatric healthcare among people with intellectual disabilities compared with the general population Children Adults Outcome Period Sex RR (95% CI) RR (95% CI) p (age) Public psychiatric healthcare among those with private healthcare Pre-pandemic Men 7.74 ( 6.66 - 9.00 ) 5.01 ( 4.60 – 5.47 ) < 0.001 Women 9.31 ( 7.40 - 11.71 ) 5.25 ( 4.91 – 5.62 ) < 0.001 p (sex) 0.139 0.257 Pandemic Men 4.35 ( 2.97 – 6.37 ) 5.78 ( 4.65 – 7.17 ) 0.335 Women 2.24 ( 1.19 – 4.20 ) 7.10 ( 6.35 – 7.95 ) 0.006 p (sex) 0.121 0.087 p (period) Men 0.005 0.037 Women < 0.001 < 0.001 Private healthcare among those with public psychiatric healthcare Pre-pandemic Men 1.03 (0.89–1.20) 0.78 ( 0.72 – 0.85 ) < 0.001 Women 0.95 (0.75–1.20) 0.84 ( 0.78 – 0.89 ) 0.178 p (sex) 0.438 0.061 Pandemic Men 0.97 (0.66–1.42) 0.60 ( 0.49 – 0.75 ) 0.036 Women 0.52 ( 0.28 – 0.97 ) 0.77 ( 0.69 – 0.86 ) 0.234 p (sex) 0.095 0.014 p (period) Men 0.767 0.004 Women 0.071 0.046 Relative risks (RRs) with 95% confidence intervals (CIs) for psychiatric healthcare among children and adults with intellectual disabilities compared with their age peers in the general population, with p values assessing risk differences between sexes [p (sex)], age groups [p (age)], and periods [p (period)]. Bold text indicates statistically significant results. Somatic healthcare vs private healthcare Among those with at least one contact in private healthcare, there was a pattern of increased risk of having at least one contact in somatic healthcare (Table 6 ; Supplement 1). Although not always statistically significant, this pattern was consistent across age groups, sexes, and periods. Among those with at least one contact in somatic healthcare, adults with ID were less likely than those in the gPop cohort were to have at least one contact in private healthcare. The effect was more pronounced among men than among women and during the pandemic period. Among children, a decreased risk of having at least one contact in private healthcare was found only during the pandemic period, with a greater effect among girls than among boys. Table 6 Somatic healthcare among people with intellectual disabilities compared with the general population Children Adults Outcome Period Sex RR (95% CI) RR (95% CI) p (age) Public somatic healthcare among those with private healthcare Pre-pandemic Men 1.12 ( 1.01 – 1.24 ) 1.04 (0.97–1.11) 0.291 Women 1.17 ( 1.01 – 1.36 ) 1.05 ( 1.00 - 1.10 ) 0.187 p (sex) 0.614 0.290 Pandemic Men 1.32 ( 1.03 – 1.71 ) 1.39 ( 1.21 – 1.59 ) 0.750 Women 1.24 (0.86–1.77) 1.16 ( 1.08 – 1.25 ) 0.672 p (sex) 0.798 0.089 p (period) Men 0.187 0.020 Women 0.642 0.240 Private healthcare among those with public somatic healthcare Pre-pandemic Men 0.98 (0.88–1.08) 0.66 ( 0.62 – 0.71 ) < 0.001 Women 0.96 (0.83–1.12) 0.71 ( 0.68 – 0.75 ) < 0.001 p (sex) 0.930 < 0.001 Pandemic Men 0.71 ( 0.55 – 0.92 ) 0.54 ( 0.47 – 0.62 ) 0.059 Women 0.53 ( 0.37 – 0.77 ) 0.57 ( 0.53 – 0.61 ) 0.788 p (sex) 0.214 0.001 p (period) Men 0.028 0.001 Women 0.003 < 0.001 Relative risks (RRs) with 95% confidence intervals (CIs) for somatic healthcare among children and adults with intellectual disabilities compared with their age peers in the general population, with p values used to assess risk differences between sexes, age groups, and periods. Bold text indicates statistically significant results. Discussion In this register‑based study, we examined overlap between the use of public and privately organised healthcare providers among children and adults with intellectual disabilities and compared these patterns with those observed in the general population. Among adults with intellectual disabilities who had contacts in public primary or specialist care, the likelihood of also having contacts with privately organized healthcare providers was lower than among adults in the general population, whereas no such difference was observed among children. In contrast, among people with contacts in privately organized healthcare, both children and adults with intellectual disabilities had similar use of public primary and somatic specialist care compared with the general population, but a higher use of public psychiatric outpatient specialist care. These patterns were observed across sexes and during both the pre‑pandemic and pandemic periods, with some variation by age group, sex, and period. A major strength of the present study is the use of population-based registers to identify both the study cohorts and healthcare utilization outcomes. The registers are maintained by national and regional authorities and cover all residents in the region, resulting in minimal risk of selection bias. A further strength is the inclusion of all people in a defined geographical area comprising both urban and rural settings and representing more than a tenth of the Swedish population, which supports the generalisability of the findings to larger populations, particularly in other welfare-based healthcare systems. In addition, the long study period increased the likelihood of capturing even infrequent use of privately organized healthcare providers. A potential weakness of the study is the limited information available on privately organized healthcare. The available data did not allow us to distinguish between different levels of care (e.g., primary vs specialist care) provided by private healthcare providers. However, by relating privately organized healthcare to all types of public healthcare (primary healthcare, specialist care, and all public healthcare combined), we were able to assess overlap in healthcare utilization across different levels of healthcare. Moreover, as diagnoses from privately organized healthcare were not available from the Skåne Healthcare Register, we were unable to identify clinical characteristics associated with a greater likelihood of using public or private healthcare, respectively. Even so, the aim of the study was to describe patterns of overlap between public and privately organized healthcare utilization, and not to examine the underlying reasons for choosing one or the other. Another potential limitation is the use of a binary measure of healthcare utilisation (having at least one contact during each period) rather than, for example, the number or proportion of contacts in privately organized healthcare. This approach was chosen to capture whether people utilised more than one type of healthcare provider within the system. Nevertheless, it limits conclusions regarding the intensity or frequency of healthcare utilization. In addition, the pre-pandemic and pandemic periods differed in length, which restricts direct comparisons of utilisation levels between periods. However, as the analyses focused on differences between cohorts within each period rather than changes over time within cohorts, this discrepancy is unlikely to have materially affected the results. Only physical healthcare contacts were included while telephone and video contacts were not. This is likely to have had the greatest impact during the pandemic period, when the use of digital consultations increased. We have previously reported that during the pandemic, people with intellectual disabilities were more likely than the general population to have video contact with specialist healthcare but less likely to have such contact with primary healthcare physicians ( 42 ). As the observed associations for the ID cohort were stronger during the pandemic period for both primary and specialist care, restricting the analyses to physical contacts is unlikely to have substantially biased the results. We would like to highlight a few of our findings. First, among people with at least one contact in privately organized healthcare, the proportion who also had at least one contact in public healthcare was high and similar in the ID and gPop cohorts, across age groups and sexes. This indicates substantial overlap in provider use, with privately organized healthcare commonly occurring alongside public healthcare. Because our analyses were restricted to physical visits to physicians, these patterns reflect physician-delivered care within these settings. When stratifying by type of public healthcare, overlap was similarly high for public primary healthcare and public somatic outpatient specialist care, although children with intellectual disabilities who used privately organized healthcare had a slightly higher likelihood of also having somatic specialist contacts. This pattern may be consistent with higher healthcare needs and more complex care pathways among children with intellectual disabilities, where privately organized healthcare alone may not cover all required services. Previous studies have reported that choice reforms can make integrated care for people with complex needs more difficult ( 15 , 16 ). Future investigations should examine whether differences in overlap are explained by variations in need, service availability, or care pathways, and to what extent they reflect barriers to obtaining coordinated care. Second, psychiatric outpatient specialist care showed a distinct pattern: among people with at least one contact in privately organized healthcare, children and adults with intellectual disabilities were markedly more likely than their peers in the general population to also have contacts in public psychiatric outpatient specialist care. In other words, psychiatric specialist contacts among people using privately organized healthcare were substantially more common in the public sector for the ID cohort. One possible explanation is that psychiatric specialist care for people with intellectual disabilities may more often be delivered through established public specialist services with long-term follow-up, which could reduce the extent of psychiatric healthcare delivered by privately organised providers. Further research is needed to clarify how service organisation and continuity of care contribute to this pattern. Third, among people with at least one contact in public healthcare, children in the ID cohort had similar likelihood of also having contacts in privately organized healthcare as children in the general population, whereas adults with intellectual disabilities were consistently less likely than their peers to have contacts in privately organized healthcare. This indicates lower utilisation of privately organised healthcare providers among adults with intellectual disabilities within a system that formally allows provider choice. A plausible explanation for the difference between children and adults is that healthcare contacts for children are more often initiated and managed by parents or caregivers, whereas adults may need to navigate provider options more independently or with variable support. Future studies should explore which factors are associated with the use of privately organised providers among adults with intellectual disabilities, including health status, severity of disability, sociodemographic factors, and social support, and should also investigate the observed sex differences. From a health‑system perspective, support functions that facilitate navigation and coordination, such as care coordinators, may be relevant to reduce fragmentation and help ensure that provider choice is accessible for people with intellectual disabilities. This is consistent with person‑centred care principles and with legal and organisational expectations that people should be able to make informed choices with appropriate support. Measures to improve accessibility may also include strengthening communication competence in both public and privately organised services and expanding accessible digital services and e‑health options. Conclusions The findings from the present study have important implications for patient‑choice‑based health systems. They indicate that formally available provider choice does not result in similar patterns of utilisation across populations. Also, that adults with intellectual disabilities may face challenges in navigating and using privately organised providers within such systems. The prominent role of public psychiatric specialist services further highlights the continued importance of publicly provided specialist care for people with intellectual disabilities. Together, the results underscore the need for patient‑choice‑based healthcare systems to be designed and implemented in ways that support accessibility, coordination, and navigation for people with intellectual disabilities, particularly adults with complex healthcare needs and during periods of healthcare disruption. Abbreviations CI Confidence interval ICD-10 International Statistical Classification of Diseases and Related Health Problems 10th Revision RR Relative risk Declarations Ethics approval and consent to participate This study was performed in accordance with the Declaration of Helsinki. Ethics approval was obtained from the Swedish Ethical Review Authority (dnr 2021 − 01444 with amendments 2021–04910 and 2021–06056). Moreover, the Swedish National Board of Health and Welfare and Statistics Sweden performed their own secrecy review before providing the data. Swedish law does not require consent to participate in register studies. Consent for publication Not applicable. Availability of data and materials Since the data comprise information about single people and are detailed enough to enable identification of, at least, some of the people included, they cannot be made publicly available. However, as the database was compiled from national register data, other researchers may contact the register holders to obtain access to the registries used in this study and thereby generate an identical database. Competing interests The authors declare that they have no competing interests. Funding This study, as well as the IDcare project, was funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE, dnr 2019 − 00105 and 2021 − 01862). Open access funding was provided by Lund University. The funder played no role in the analysis, interpretation, or reporting of this study. Author contributions Conceptualization: AA, MS. KE; Methodology: AA, MS. KE; Software: AA; Validation: MS; Formal analysis: AA; Investigation: AA; Resources: AA, MS; Data curation: AA; Writing – original draft: AA; Writing – review & editing: AA, MS, KE; Visualization: AA; Supervision: AA, MS; Project administration: MS; Funding acquisition: AA, MS. Acknowledgements Not applicable. References Organisation for Economic Co-operation and Development (OECD). Competition in the provision of hospital services. Organisation for Economic Co-operation and Development (OECD); 2005. Vrangbaek K, Robertson R, Winblad U, Van De Bovenkamp H, Dixon A. Choice policies in Northern European health systems. Health Econ Policy Law. 2012;7(1):47–71. Sweden Go. Government Bill on the Act on System of Choice in the Public Sector [In Swedish: Proposition om lag om valfrihetssystem]. 2008. Report No.: Prop. 2008/09:29. Giusti A, Nkhoma K, Petrus R, Petersen I, Gwyther L, Farrant L, et al. The empirical evidence underpinning the concept and practice of person-centred care for serious illness: a systematic review. BMJ Global Health. 2020;5(12):e003330. Toro N. Who global strategy on integrated people-centred health services (IPCHS) / Estrategia mundial en servicios de salud integrada centrado en las personas (IPCHS). 3rd World Congress on Integrated Care; Mexico City. Mexico: International Journal of Integrated Care; 2015. Ge G, Iversen T, Kaarbøe O, Snilsberg Ø. Impacts of Norway's extended free choice reform on waiting times and hospital visits. Health Econ. 2024;33(4):779–803. Moscelli G, Gravelle H, Siciliani L. The effect of hospital choice and competition on inequalities in waiting times. J Econ Behav Organ. 2023;205:169–201. Moscelli G, Gravelle H, Siciliani L. Hospital competition and quality for non-emergency patients in the English NHS. RAND J Econ. 2021;52(2):382–414. Brekke KR, Canta C, Siciliani L, Straume OR. Hospital competition in a national health service: Evidence from a patient choice reform. J Health Econ. 2021;79:102509. Jiang Q, Tian F, Liu Z, Pan J. Hospital Competition and Unplanned Readmission: Evidence from a Systematic Review. Risk Manag Healthc Policy. 2021;14:473–89. Gustafsson PE, Fonseca-Rodríguez O, San Sebastián M, Burström B, Mosquera PA. Evaluating the impact of the 2010 Swedish choice reform in primary health care on avoidable hospitalization and socioeconomic inequities: an interrupted time series analysis using register data. BMC Health Serv Res. 2024;24(1):972. Fredriksson M, Isaksson D. Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know? Scand J Public Healt. 2022;50(7):852–63. Kohnke H, Zielinski A, Beckman A, Ohlsson H. Trajectories of primary health care utilization: a 10-year follow-up after the Swedish Patient Choice Reform of primary health care. BMC Health Serv Res. 2023;23(1):1294. Holom GH, Alexandersen N, Goldhaber-Fiebert JD, Hagen TP. Which patients receive surgery in for-profit and non-profit hospitals in a universal health system? An explorative register-based study in Norway. BMJ Open. 2018;8(6):e019780. Burström B, Burström K, Nilsson G, Tomson G, Whitehead M, Winblad U. Equity aspects of the Primary Health Care Choice Reform in Sweden - a scoping review. Int J Equity Health. 2017;16(1):29. Shen VC-Y, Ward WJ, Chen L-K. Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care. Arch Gerontol Geriatr. 2019;83:263–70. Liao P, Vajdic C, Trollor J, Reppermund S. Prevalence and incidence of physical health conditions in people with intellectual disability - a systematic review. PLoS ONE. 2021;16(8):e0256294. Mazza MG, Rossetti A, Crespi G, Clerici M. Prevalence of co-occurring psychiatric disorders in adults and adolescents with intellectual disability: A systematic review and meta-analysis. J Appl Res Intellect Disabil. 2020;33(2):126–38. Horner-Johnson W, Klein KA, Campbell J, Guise JM. It Would Have Been Nice to Have a Choice: Barriers to Contraceptive Decision-making among Women with Disabilities. Womens Health Issues. 2022;32(3):261–7. Sheehan R, Hassiotis A, Strydom A, Morant N. Experiences of psychotropic medication use and decision-making for adults with intellectual disability: a multistakeholder qualitative study in the UK. BMJ Open. 2019;9(11):e032861. Sheerin J, Larkin F, Dockray S. Perceptions of People With Intellectual Disabilities on Autonomy and Decision-Making in Daily Life: A Systematic Review and Synthesis of Qualitative Studies. J Intellect Disabil Res. 2025. Vallury KD, Tucker V, Sheeran N. Contraceptive and Pregnancy Decision-Making Autonomy and Health Care Experiences Among Women With Intellectual Disabilities. J Intellect Disabil Res. 2025;69(4):274–82. Casey H, Trayer Á, Desmond D, Coffey L. Experiences and perceptions of everyday decision-making in the lives of adults with intellectual disabilities, their care partners and direct care support workers. J Intellect Disabil. 2025;29(3):683–705. Noorlandt HW, Korfage IJ, Tuffrey-Wijne I, Festen D, Vrijmoeth C, van der Heide A, et al. Consensus on a conversation aid for shared decision making with people with intellectual disabilities in the palliative phase. J Appl Res Intellect. 2021;34(6):1538–48. Hutchinson C, Milte R, Stanley M, Duff G, Ratcliffe J. Using discrete choice experiments to elicit the service preferences of people with mild intellectual disability: An exploratory study. Health Soc Care Community. 2022;30(4):e1396–405. Downs J, Keeley J, Skoss R, Mills J, Nevill T, Schippers A, et al. Perspectives on the essential skills of healthcare decision making in children and adolescents with intellectual disability. Int J Equity Health. 2024;23(1):119. Robitaille MJ, Gauthier-Boudreault C, Rochon V. How can we support people with profound intellectual and multiple disabilities in enhancing their self-determination? A scoping review. J Intellect Dev Disabil. 2025:1–13. Skarsaune SN. Self-determination of people with profound intellectual and multiple disabilities. Dev Med Child Neurol. 2023;65(1):16–23. Komenda-Schned S, Landskron SJ, Moritz P, Braunstein N, Hochmeister J, Riegler K, et al. Good mental health for people with intellectual disabilities: a participatory focus group study. Int J Equity Health. 2025;24(1):180. Komenda-Schned S, Moritz P, Landskron SJ, Herscovici AR, Schomburg C, Lehner J, et al. Exploring good mental health for people with intellectual disabilities: a qualitative interview study with mental health experts. Int J Equity Health. 2025;24(1):172. Wehmeyer ML. The Importance of Self-Determination to the Quality of Life of People with Intellectual Disability: A Perspective. Int J Environ Res Public Health. 2020;17:19. Wehmeyer ML. Self-determination in adolescents and adults with intellectual and developmental disabilities. Curr Opin Psychiatry. 2020;33(2):81–5. The Swedish National Board of Health and Welfare. Analys av första och andra covid-19-vågen - produktion, köer och väntetider i vården. 2021. Axmon A, Kristensson J, Sandberg M. Pre-pandemic and pandemic healthcare utilization among older people with intellectual disabilities compared to the general population (IDcare). J Public Health. 2025. Region Skåne, Öppenvård. Region Skåne; 2025 [Available from: https://vardgivare.skane.se/patientadministration/avgifter-och-prislistor/patientavgifter/besok-annan-personal/ Region Skåne. Högkostnadsskydd och frikort: Region Skåne. 2025 [Available from: https://vardgivare.skane.se/patientadministration/avgifter-och-prislistor/patientavgifter/hogkostnadsskydd-frikort/ Act on System of Choice in the Public Sector [In Swedish: Lag om valfrihetssystem]. (2008). Sveriges Kommuner och Regioner. Regionen i siffror 2025. En beskrivning av regionernas verksamhet och ekonomi. Sveriges Kommuner och Regioner; 2025. Janlöv N, Merkur S, Sweden. Health System Summary, 2024. Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe; 2024. Janlöv N, Blume S, Glenngård A, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Syst Transition. 2023;25(4):i–198. Sandberg M, Kristensson J, Axmon A. IDcare - a longitudinal register study of pre-pandemic and pandemic health care utilization and diagnostic profiles among people with intellectual disabilities in southern Sweden. Eur J Epidemiol. 2024;39(9):1063–71. Sandberg M, Chadwick D, Axmon A, editors. Digital healthcare utilization during the COVID-19 pandemic among people with intellectual disabilities compared to the general population (IDcare). Munich: IASSIDD Europe; 2026. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9263449","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":622399439,"identity":"a2ff8958-42f1-423f-b505-d3b4d7eaaafb","order_by":0,"name":"Anna Axmon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYHAD5gMMDGwMMqRoYUsAaeEhRQuPAXFa+Gf3HvzAUHM4ml+65+uGD2VAjQfYHz7Ap0XizrlkCYZjabkz55zddnPGOZAWHmMDvNbcyDGQYGCzyd1wI3fbbd42sBY2CXw65G/kGP9g+CcB1JLz7PZfsBb25z/waTG4kWMmwdgGsiWH7TYjWAuDGV53GQK1WCT2Af0yI83sZs85CR7JwzzGeB0mB3TYjQ/fDuf2SyQ/u/GjzEaO73j7ww94rQGBBAQTaD4zQfWjYBSMglEwCggBAIbRSMdJGcyUAAAAAElFTkSuQmCC","orcid":"","institution":"Lund University","correspondingAuthor":true,"prefix":"","firstName":"Anna","middleName":"","lastName":"Axmon","suffix":""},{"id":622399441,"identity":"e6831027-acbf-45a6-82a0-5304cb6a84ba","order_by":1,"name":"Karin Engström","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Karin","middleName":"","lastName":"Engström","suffix":""},{"id":622399442,"identity":"878a67e6-233f-458e-aeeb-5d8e9ada0557","order_by":2,"name":"Magnus Sandberg","email":"","orcid":"","institution":"Lund University","correspondingAuthor":false,"prefix":"","firstName":"Magnus","middleName":"","lastName":"Sandberg","suffix":""}],"badges":[],"createdAt":"2026-03-30 07:10:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9263449/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9263449/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107480668,"identity":"ef484aa3-7a12-4541-87e5-553c3059ef87","added_by":"auto","created_at":"2026-04-22 02:13:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":981225,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9263449/v1/cfe042a9-f02b-4aba-95c4-7a662df49e7d.pdf"},{"id":107059914,"identity":"1474a3c4-b9c5-42f9-8a0a-492b0c103558","added_by":"auto","created_at":"2026-04-16 09:59:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":57234,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9263449/v1/c866a41f3edfb956e69aef16.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Access to choice‑enabled healthcare providers among children and adults with intellectual disabilities in comparison with the general population (IDcare)","fulltext":[{"header":"Background","content":"\u003cp\u003eIn a healthcare systems, one policy approach intended to strengthen patient\u0026rsquo;s influence over their healthcare is the introduction of patient choice systems, in which people are free to choose between different healthcare providers. During the early 2000s, several European countries introduced such systems, allowing people to choose between public and private healthcare providers within a patient-choice-based health system, with the aim of increasing patients\u0026rsquo; influence over their care and improving healthcare quality through competition (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These reforms can be conceptually linked to the broader shift towards person-centred care, which emphasises responsiveness to patients\u0026rsquo; needs and preferences (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In healthcare systems that formally allow patients to choose between public and private healthcare providers, the use of more than one type of provider can be viewed as an indicator of realised use of the available choice options within the system. However, evidence of consistent positive effects is limited, including for waiting times (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), number of visits (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), mortality (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), hospital length of stay (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and hospital readmissions (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Instead, the introduction of free choice of care has been associated with increased inequities (\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and may also complicate the delivery of integrated care (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIntellectual disability is a condition that is present from early life and diagnosed before the age of 18 years, characterized by limited cognitive ability and understanding. People with intellectual disabilities are known to have poorer somatic (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and mental (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) health than the general population, and they often have complex healthcare needs. As a result, people with intellectual disabilities may be particularly vulnerable in healthcare systems that rely on patients\u0026rsquo; ability to navigate available options and actively choose between providers. This concern is supported by studies showing that people with intellectual disabilities experience barriers in shared decision-making (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), despite expressing a desire to be involved in decisions regarding their own healthcare (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and evidence that supported decision-making can be successfully implemented in some contexts (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), particularly when appropriate support is provided (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), and research showing that self-determination is associated with mental health (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), quality of life (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and life satisfaction (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Little is known about how people with intellectual disabilities utilise patient choice options within healthcare systems that formally offer free choice of provider.\u003c/p\u003e \u003cp\u003eIn studies of healthcare choice, it is important to consider that for children \u0026ndash; both with and without disabilities \u0026ndash; seeking healthcare relies more on the parent than on the child. Therefore, there may be different processes in the choice of healthcare providers for children and adults. Such differences can be identified only by assessing children and adults separately.\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic had a major impact on healthcare services. In Sweden, the high demand put on the healthcare system resulted in, e.g., a decrease in surgeries and somatic inpatient care and fewer contacts with physicians in specialist outpatient care (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Although previous studies have not found clear evidence of discrimination against children (unpublished results) or older people (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) with intellectual disabilities, studies on healthcare utilization need to consider differences in healthcare delivery between the pre-pandemic and pandemic periods.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003e This register-based study uses national and regional registers to both identify the study population and collect outcome data. We operationalised access to choice-enabled providers as observed utilisation across provider types, which reflects realised use of available options rather than the availability of choice per se or people\u0026rsquo; ability to actively choose providers. Thus, the aim of the present study was to assess the overlap between the use of public and private healthcare providers as an indicator of access to choice-enabled healthcare providers within a patient-choice-based health system among children and adults with intellectual disabilities in comparison to the general population during pre-pandemic (2014\u0026ndash;2019) and pandemic periods (2020\u0026ndash;2021).\u003c/p\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThis study is set in Sk\u0026aring;ne (Scania), the southernmost region of Sweden. In September of 2025, the population of Sk\u0026aring;ne was approximately 1.4\u0026nbsp;million, which corresponds to approximately 13% of the Swedish population. The administrative unit for Sk\u0026aring;ne, i.e., the county council, is called Region Sk\u0026aring;ne.\u003c/p\u003e \u003cp\u003eSwedish healthcare is part of the welfare system and is financed mainly by taxes. Patients pay only a small fee, which may vary across counties. In Sk\u0026aring;ne, the number of consultations with physicians in primary healthcare and outpatient specialist care is 200 SEK (approximately \u0026euro;17, conversion made November 24, 2025)(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). In all of Sweden, there is a yearly cap of 1450 SEK (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), corresponding to approximately \u0026euro;122. Thus, a patient would never pay more than this amount over a 12-month period. Basic healthcare is provided in primary healthcare. These may be either public or privately organized. Healthcare requiring specialized care is provided at hospitals or by private healthcare providers. The fee is the same in public healthcare and in privately organized healthcare, provided that the private healthcare provider is under contract with the county council.\u003c/p\u003e \u003cp\u003eAccording to the Swedish Act on System of Choice in the Public Sector (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), which was introduced in 2009, patients are free to choose their own healthcare provider in both primary and specialist care. This legislation establishes a formal patient-choice-based healthcare system, in which patients may choose between publicly and privately operated providers included in the regional healthcare system. Consequently, privately organized healthcare within the regional system represents access to alternative, choice-enabled healthcare providers rather than privately financed care.\u003c/p\u003e \u003cp\u003eThe availability of private healthcare providers varies between types of care. For example, approximately 50% of all physical contacts in primary healthcare are to private healthcare providers, but most of these are not to physicians but to physiotherapists and occupational therapists (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In both somatic and psychiatric specialist care, approximately 20% of healthcare contacts are private healthcare providers, the majority of which are in an open care setting. However, most hospitals are owned and operated by regions (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Approximately 86% of all expenditures on healthcare are public expenditures (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), suggesting that healthcare contacts with private healthcare providers not under contract with county councils are limited.\u003c/p\u003e \u003cp\u003eAccording to the Swedish Act Concerning Support and Service for Persons with Certain Functional Impairments (the LSS law), people with intellectual disability and/or autism spectrum disorder are entitled to the service and support they need to live fulfilling lives. These services and support include, e.g., daily activities, housing, and personal assistance but not financial aid. The services and support are provided by the municipality after application from the individual or their care takers, followed by a need assessment. As a rule, support according to the LSS act is free of charge, but the municipality may charge for costs associated with supported living (mainly rent) and for leisure time and cultural activities.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData sources\u003c/h2\u003e \u003cp\u003eThe Sk\u0026aring;ne Healthcare Register comprises data on all public healthcare and healthcare provided by private healthcare providers under contract with Region Sk\u0026aring;ne. Each record includes the date of the healthcare contact, which healthcare area (e.g., primary healthcare or somatic specialist care) the contact was recorded in, the profession of the treating person, and the type of contact (e.g., in person or phone) as well as information on the patient, such as sex and age. Moreover, records from public healthcare comprise both primary and secondary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).\u003c/p\u003e \u003cp\u003eThe LSS register at the Swedish National Board of Health and Welfare includes data on all services and support provided according to the LSS law. Although a diagnosis of intellectual disability or autism spectrum disorder is required to be eligible for LSS support, diagnoses are not recorded in the LSS register.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy populations\u003c/h3\u003e\n\u003cp\u003eThis study is based on the IDcare study (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In IDcare, we included all people living in Sk\u0026aring;ne on January 1st, 2014. People with at least one measure of service and support according to the LSS act from 2007 to 2021 and/or people with at least one diagnosis of intellectual disability (F70\u0026ndash;F79 in the ICD-10) or Down syndrome (Q90) from 2014 to 2021 were included in the ID cohort (n\u0026thinsp;=\u0026thinsp;14 716; 5 939 women and 8 777 men). As people living with a person with intellectual disabilities may differ from people not living with such a person regarding health and healthcare utilization, we excluded those who were not in the ID cohort but in the same family or household as a person in the ID cohort (n\u0026thinsp;=\u0026thinsp;31 688). The remaining population of Sk\u0026aring;ne comprised the general population reference cohort (gPop cohort, n\u0026thinsp;=\u0026thinsp;1 226 955; 620 032 women and 606 923 men). For the present study, we identified those who were either \u003cb\u003echildren\u003c/b\u003e (i.e., \u0026lt;\u0026thinsp;18 years old, corresponding to being born from 2004 to 2014) or \u003cb\u003eadults\u003c/b\u003e (i.e., \u0026gt;\u0026thinsp;18 years old, corresponding to being born before 1996) during the entire study period, excluding those aged 18 years from 2014 to 2021. If not otherwise implied, the terms men and women will henceforth be used to describe the adult population by sex and boys and girls to describe the children by sex.\u003c/p\u003e\n\u003ch3\u003eHealthcare utilization\u003c/h3\u003e\n\u003cp\u003eData regarding healthcare utilization were collected from the Sk\u0026aring;ne Healthcare Register. We selected all physical contacts (i.e., excluding phone and video consultations) with physicians if they were recorded in healthcare areas public primary healthcare (henceforth referred to as \u003cb\u003eprimary healthcare\u003c/b\u003e), privately organized healthcare for care providers under contract with Region Sk\u0026aring;ne (\u003cb\u003eprivate healthcare\u003c/b\u003e), public psychiatric outpatient specialist care (\u003cb\u003epsychiatric healthcare\u003c/b\u003e), or public somatic outpatient specialist care (\u003cb\u003esomatic healthcare\u003c/b\u003e). For each healthcare area, we determined whether each person had at least one visit during the pre-pandemic (2014\u0026ndash;2019) and pandemic (2020\u0026ndash;2021) periods.\u003c/p\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eWe assessed the overlap between public and private healthcare utilization within the publicly funded healthcare system in two different ways. 1) Among people with at least one visit in \u003cb\u003eprivate\u003c/b\u003e healthcare during each period (pre-pandemic and pandemic), we compared the number of people with at least one visit during the study period in each of the public healthcare areas in the ID cohort with that in the gPop cohort. 2) Among people with at least one visit in each \u003cb\u003epublic\u003c/b\u003e healthcare area during each period, we assessed the number of people with at least one visit during the study period in private healthcare.\u003c/p\u003e \u003cp\u003eComparisons of the ID cohort to the gPop cohort were performed using Poisson regression to estimate relative risks (RRs) with 95% confidence intervals (CIs). All analyses were stratified by age group (children and adults) and sex and adjusted for year of birth. The interaction between age group and cohort, i.e., whether the potential association between the ID cohort and the outcome differed between children and adults, was assessed via models including age group, cohort, and the cross-term between the age group and cohort. Similarly, the interaction between sex and cohort was assessed in models including sex, cohort, and the cross-term between sex and cohort, and the interaction between period and cohort was assessed in models including period, cohort, and the cross-term between period and cohort.\u003c/p\u003e \u003cp\u003eAll analyses were performed in IBM SPSS Statistics 30.0. p values less than 0.05 were considered statistically significant. To avoid the identification of single people as well as in consideration of statistical power, the results are presented only for groups comprising at least five people.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePopulation characteristics\u003c/h2\u003e \u003cp\u003eThe ID cohort comprised 2 813 children (1 864 boys and 949 girls) and 9 079 adults (5 154 men and 3 925 women), whereas the gPop cohort comprised 146 048 children (74 526 boys and 71 522 girls) and 982 186 adults (481 843 men and 500 343 women). The children in the ID cohort were slightly older than the children in the gPop cohort were (median year of birth 2008 \u003cem\u003evs\u003c/em\u003e 2009), whereas the opposite was observed among the adults (median year of birth 1981 \u003cem\u003evs\u003c/em\u003e 1965).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHealthcare utilization\u003c/h3\u003e\n\u003cp\u003eThe percentage of people with at least one contact in \u003cb\u003eprivate healthcare\u003c/b\u003e ranged from 5% among boys and girls in the ID cohort during the pandemic period to 70% among women in the gPop cohort during the pre-pandemic period (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among adults, there was a pattern of greater use among women than among men in both cohorts and during both periods. The percentage of people with at least one contact in \u003cb\u003eany public healthcare\u003c/b\u003e was high in both cohorts, with almost 100% among children and adults in the ID cohort during the pre-pandemic period. The overlap between private and public healthcare utilization, i.e., the number of people with at least one contact in private healthcare as well as at least one contact in each type of public healthcare, is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber and percentage of people with at least one contact in each type of healthcare\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"20\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHealthcare\u0026nbsp;area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c11\" namest=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChildren\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c19\" namest=\"c12\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdults\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003egPop\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eID\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c15\" namest=\"c12\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003egPop\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c19\" namest=\"c16\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eID\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrivate healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15 205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e149 446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e1 023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e13 162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e348 195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e1 935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAny public healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e69 930\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1 835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e431 311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e5 030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e66 633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e473 009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e3 852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrimary healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e66 516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1 668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e406 190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e4 807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e63 708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e456 978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e3 766\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePsychiatric healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e31 528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e2 190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2 594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e34 768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e1 614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSomatic healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e54 630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1 645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e346 628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e3 813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e49 715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e406 578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e3 273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrivate healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e56 953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e242 028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e1 096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAny public healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e47 566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1 489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e313 686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e4 112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e45 698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e369 081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e3 248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrimary healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e36 915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e271 035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e3 558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e37 085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e331 008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e2 935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePsychiatric healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e15 567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e1 292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3 978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e17 028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSomatic healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e28 040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1 071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e213 776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e2 513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e25 884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e263 436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c18\" namest=\"c17\"\u003e \u003cp\u003e2 235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"20\"\u003e\u003cem\u003eID\u0026thinsp;=\u0026thinsp;a cohort of people with intellectual disabilities, gPop\u0026thinsp;=\u0026thinsp;a referent cohort of people from the general population\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eAny public healthcare vs private healthcare\u003c/h3\u003e\n\u003cp\u003eAmong those with at least one contact in private healthcare, men and women in the ID cohort were 17% and 11%, respectively, more likely than those in the gPop cohort to have at least one contact in public healthcare during the pandemic period (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; Supplement 1). Although the risk estimates were similar for adults and children, the risks for boys and girls did not achieve statistical significance. Moreover, there were no statistically significant sex, age, or period effects.\u003c/p\u003e \u003cp\u003eAmong those with at least one contact in public healthcare, both men and women in the ID cohort were less likely to have contact in private healthcare during both periods. The effect was more pronounced among men and during the pandemic period. For children, no difference in the risk of private healthcare was found between the cohorts for the pre-pandemic period, but during the pandemic period, both boys and girls in the ID cohort had a decreased risk of having at least one contact in private healthcare.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverlap between public and private healthcare contacts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"17\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHealthcare area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c10\" namest=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChildren\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c17\" namest=\"c11\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdults\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003egPop\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eID\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003egPop\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c17\" namest=\"c14\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eID\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003csub\u003epu\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003csub\u003epr\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003csub\u003epu\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e%\u003csub\u003epr\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e%\u003csub\u003epu\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e%\u003csub\u003epr\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e%\u003csub\u003epu\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e%\u003csub\u003epr\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAny public healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u0026nbsp;886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e145\u0026nbsp;375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u0026nbsp;013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e339 425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1 913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrimary healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e139 298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e330 255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1 886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePsychiatric healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11 210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e24 245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSomatic healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e127 561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e296 546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1 676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAny public healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e50 216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e209 878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1 029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrimary healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44 771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 936\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e188 777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePsychiatric healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e8 004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSomatic healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e38 453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e150 567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c17\" namest=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"17\"\u003e\u003cem\u003eID\u0026thinsp;=\u0026thinsp;a cohort of people with intellectual disabilities, gPop\u0026thinsp;=\u0026thinsp;a referent cohort of people from the general population, %\u003c/em\u003e\u003csub\u003e\u003cem\u003epu\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e= percentage with private healthcare of those with public healthcare, %\u003c/em\u003e\u003csub\u003e\u003cem\u003epr\u003c/em\u003e\u003c/sub\u003e \u003cem\u003e= percentage with public healthcare of those with private healthcare\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAny public healthcare among people with intellectual disabilities compared with the general population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChildren\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdults\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u0026nbsp;(age)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eAny public healthcare among those with private healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02\u0026nbsp;(0.92\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.03\u0026nbsp;(0.97\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02\u0026nbsp;(0.88\u0026ndash;1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02\u0026nbsp;(0.97\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.17\u0026nbsp;(0.95\u0026ndash;1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.17\u003c/b\u003e\u0026nbsp;(\u003cb\u003e1.04\u003c/b\u003e\u0026ndash;\u003cb\u003e1.33\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.17\u0026nbsp;(0.87\u0026ndash;1.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.11\u003c/b\u003e\u0026nbsp;(\u003cb\u003e1.05\u003c/b\u003e\u0026ndash;\u003cb\u003e1.18\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep (period)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePrivate healthcare among those with any public healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02\u0026nbsp;(0.92\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.69\u003c/b\u003e\u0026nbsp;(\u003cb\u003e0.65\u003c/b\u003e\u0026ndash;\u003cb\u003e0.73\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04\u0026nbsp;(0.90\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e\u0026nbsp;(\u003cb\u003e0.68\u003c/b\u003e\u0026ndash;\u003cb\u003e0.74\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e\u0026nbsp;(\u003cb\u003e0.62\u003c/b\u003e\u0026ndash;\u003cb\u003e0.96\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.47\u003c/b\u003e\u0026nbsp;(\u003cb\u003e0.41\u003c/b\u003e\u0026ndash;\u003cb\u003e0.53\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e\u0026nbsp;(\u003cb\u003e0.50\u003c/b\u003e\u0026ndash;\u003cb\u003e0.91\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.55\u003c/b\u003e\u0026nbsp;(\u003cb\u003e0.52\u003c/b\u003e\u0026ndash;\u003cb\u003e0.59\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep (period)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eRelative risks (RRs) with 95% confidence intervals (CIs) for\u003c/em\u003e \u003cb\u003eany public healthcare\u003c/b\u003e \u003cem\u003eamong children and adults with intellectual disabilities compared with their age peers in the general population, with p values assessing risk differences between sexes [p (sex)], age groups [p (age)], and periods [p (period)]. Bold text indicates statistically significant results.\u003c/em\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrimary healthcare vs private healthcare\u003c/h2\u003e \u003cp\u003eAmong those with at least one contact in private healthcare, there was a 26% increased risk for men and a 19% increased risk for women in the ID cohort to have at least one contact in primary healthcare during the pandemic period (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e; Supplement 1). For women, this risk was statistically significantly greater than that in the pre-pandemic period. No effects were found among boys and girls in the ID cohort, nor were there any other statistically significant age, sex, or period effects.\u003c/p\u003e \u003cp\u003eAmong those with at least one contact in primary healthcare, adults had a decreased risk of having at least one contact in private healthcare. The risk associated with the ID cohort was more pronounced among men and during the pandemic period. No effects were found for the children in the ID cohort.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary healthcare among people with intellectual disabilities compared with the general population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChildren\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdults\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep (age)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePublic primary healthcare among those with private healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98 (0.88\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.05 (0.99\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02 (0.88\u0026ndash;1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.03 (0.99\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99 (0.76\u0026ndash;1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.26\u003c/b\u003e (\u003cb\u003e1.11\u003c/b\u003e\u0026ndash;\u003cb\u003e1.44\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.07 (0.76\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.19\u003c/b\u003e (\u003cb\u003e1.12\u003c/b\u003e\u0026ndash;\u003cb\u003e1.27\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep (period)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePrivate healthcare among those with public primary healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02 (0.92\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e (\u003cb\u003e0.64\u003c/b\u003e\u0026ndash;\u003cb\u003e0.72\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.09 (0.94\u0026ndash;1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e (\u003cb\u003e0.68\u003c/b\u003e\u0026ndash;\u003cb\u003e0.74\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80 (0.62\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.47\u003c/b\u003e (\u003cb\u003e0.42\u003c/b\u003e\u0026ndash;\u003cb\u003e0.54\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73 (0.52\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.57\u003c/b\u003e (\u003cb\u003e0.53\u003c/b\u003e\u0026ndash;\u003cb\u003e0.60\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep (period)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eRelative risks (RRs) with 95% confidence intervals (CIs) for\u003c/em\u003e \u003cb\u003eprimary healthcare\u003c/b\u003e \u003cem\u003eamong children and adults with intellectual disabilities compared with their age peers in the general population, with p values assessing risk differences between sexes [p (sex)], age groups [p (age)], and periods [p (period)]. Bold text indicates statistically significant results.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePsychiatric healthcare vs private healthcare\u003c/h2\u003e \u003cp\u003eAmong those with at least one contact in private healthcare, children and adults in the ID cohort were up to nine times more likely to have at least one contact in psychiatric healthcare (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e; Supplement 1). During the pre-pandemic period, the risk was greater among children than among adults, whereas the opposite was found during the pandemic period. Moreover, whereas the risk decreased over time for children, it increased for adults.\u003c/p\u003e \u003cp\u003eAmong those with at least one contact in psychiatric healthcare, adults had a decreased risk of having at least one contact in private healthcare. The effect was more pronounced during the pandemic period and among men. Among children, particularly girls, there was a decreased risk of having at least one contact in private healthcare during the pandemic but not during the pre-pandemic period.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePsychiatric healthcare among people with intellectual disabilities compared with the general population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChildren\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdults\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep (age)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePublic psychiatric healthcare among those with private healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e7.74\u003c/b\u003e (\u003cb\u003e6.66\u003c/b\u003e-\u003cb\u003e9.00\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5.01\u003c/b\u003e (\u003cb\u003e4.60\u003c/b\u003e\u0026ndash;\u003cb\u003e5.47\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e9.31\u003c/b\u003e (\u003cb\u003e7.40\u003c/b\u003e-\u003cb\u003e11.71\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5.25\u003c/b\u003e (\u003cb\u003e4.91\u003c/b\u003e\u0026ndash;\u003cb\u003e5.62\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.35\u003c/b\u003e (\u003cb\u003e2.97\u003c/b\u003e\u0026ndash;\u003cb\u003e6.37\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5.78\u003c/b\u003e (\u003cb\u003e4.65\u003c/b\u003e\u0026ndash;\u003cb\u003e7.17\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.24\u003c/b\u003e (\u003cb\u003e1.19\u003c/b\u003e\u0026ndash;\u003cb\u003e4.20\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7.10\u003c/b\u003e (\u003cb\u003e6.35\u003c/b\u003e\u0026ndash;\u003cb\u003e7.95\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep (period)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePrivate healthcare among those with public psychiatric healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03 (0.89\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.78\u003c/b\u003e (\u003cb\u003e0.72\u003c/b\u003e\u0026ndash;\u003cb\u003e0.85\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95 (0.75\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.84\u003c/b\u003e (\u003cb\u003e0.78\u003c/b\u003e\u0026ndash;\u003cb\u003e0.89\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97 (0.66\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.60\u003c/b\u003e (\u003cb\u003e0.49\u003c/b\u003e\u0026ndash;\u003cb\u003e0.75\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.52\u003c/b\u003e (\u003cb\u003e0.28\u003c/b\u003e\u0026ndash;\u003cb\u003e0.97\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.77\u003c/b\u003e (\u003cb\u003e0.69\u003c/b\u003e\u0026ndash;\u003cb\u003e0.86\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep (period)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eRelative risks (RRs) with 95% confidence intervals (CIs) for\u003c/em\u003e \u003cb\u003epsychiatric healthcare\u003c/b\u003e \u003cem\u003eamong children and adults with intellectual disabilities compared with their age peers in the general population, with p values assessing risk differences between sexes [p (sex)], age groups [p (age)], and periods [p (period)]. Bold text indicates statistically significant results.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSomatic healthcare vs private healthcare\u003c/h2\u003e \u003cp\u003eAmong those with at least one contact in private healthcare, there was a pattern of increased risk of having at least one contact in somatic healthcare (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e; Supplement 1). Although not always statistically significant, this pattern was consistent across age groups, sexes, and periods.\u003c/p\u003e \u003cp\u003eAmong those with at least one contact in somatic healthcare, adults with ID were less likely than those in the gPop cohort were to have at least one contact in private healthcare. The effect was more pronounced among men than among women and during the pandemic period. Among children, a decreased risk of having at least one contact in private healthcare was found only during the pandemic period, with a greater effect among girls than among boys.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSomatic healthcare among people with intellectual disabilities compared with the general population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eChildren\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdults\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep (age)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePublic somatic healthcare among those with private healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.12\u003c/b\u003e (\u003cb\u003e1.01\u003c/b\u003e\u0026ndash;\u003cb\u003e1.24\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.04 (0.97\u0026ndash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.17\u003c/b\u003e (\u003cb\u003e1.01\u003c/b\u003e\u0026ndash;\u003cb\u003e1.36\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.05\u003c/b\u003e (\u003cb\u003e1.00\u003c/b\u003e-\u003cb\u003e1.10\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.32\u003c/b\u003e (\u003cb\u003e1.03\u003c/b\u003e\u0026ndash;\u003cb\u003e1.71\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.39\u003c/b\u003e (\u003cb\u003e1.21\u003c/b\u003e\u0026ndash;\u003cb\u003e1.59\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.24 (0.86\u0026ndash;1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.16\u003c/b\u003e (\u003cb\u003e1.08\u003c/b\u003e\u0026ndash;\u003cb\u003e1.25\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep (period)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003ePrivate healthcare among those with public somatic healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePre-pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98 (0.88\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.66\u003c/b\u003e (\u003cb\u003e0.62\u003c/b\u003e\u0026ndash;\u003cb\u003e0.71\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96 (0.83\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e (\u003cb\u003e0.68\u003c/b\u003e\u0026ndash;\u003cb\u003e0.75\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.71\u003c/b\u003e (\u003cb\u003e0.55\u003c/b\u003e\u0026ndash;\u003cb\u003e0.92\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.54\u003c/b\u003e (\u003cb\u003e0.47\u003c/b\u003e\u0026ndash;\u003cb\u003e0.62\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.53\u003c/b\u003e (\u003cb\u003e0.37\u003c/b\u003e\u0026ndash;\u003cb\u003e0.77\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.57\u003c/b\u003e (\u003cb\u003e0.53\u003c/b\u003e\u0026ndash;\u003cb\u003e0.61\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep (sex)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep (period)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eRelative risks (RRs) with 95% confidence intervals (CIs) for\u003c/em\u003e \u003cb\u003esomatic healthcare\u003c/b\u003e \u003cem\u003eamong children and adults with intellectual disabilities compared with their age peers in the general population, with p values used to assess risk differences between sexes, age groups, and periods. Bold text indicates statistically significant results.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this register‑based study, we examined overlap between the use of public and privately organised healthcare providers among children and adults with intellectual disabilities and compared these patterns with those observed in the general population. Among adults with intellectual disabilities who had contacts in public primary or specialist care, the likelihood of also having contacts with privately organized healthcare providers was lower than among adults in the general population, whereas no such difference was observed among children. In contrast, among people with contacts in privately organized healthcare, both children and adults with intellectual disabilities had similar use of public primary and somatic specialist care compared with the general population, but a higher use of public psychiatric outpatient specialist care. These patterns were observed across sexes and during both the pre‑pandemic and pandemic periods, with some variation by age group, sex, and period.\u003c/p\u003e \u003cp\u003eA major strength of the present study is the use of population-based registers to identify both the study cohorts and healthcare utilization outcomes. The registers are maintained by national and regional authorities and cover all residents in the region, resulting in minimal risk of selection bias. A further strength is the inclusion of all people in a defined geographical area comprising both urban and rural settings and representing more than a tenth of the Swedish population, which supports the generalisability of the findings to larger populations, particularly in other welfare-based healthcare systems. In addition, the long study period increased the likelihood of capturing even infrequent use of privately organized healthcare providers.\u003c/p\u003e \u003cp\u003eA potential weakness of the study is the limited information available on privately organized healthcare. The available data did not allow us to distinguish between different levels of care (e.g., primary vs specialist care) provided by private healthcare providers. However, by relating privately organized healthcare to all types of public healthcare (primary healthcare, specialist care, and all public healthcare combined), we were able to assess overlap in healthcare utilization across different levels of healthcare. Moreover, as diagnoses from privately organized healthcare were not available from the Sk\u0026aring;ne Healthcare Register, we were unable to identify clinical characteristics associated with a greater likelihood of using public or private healthcare, respectively. Even so, the aim of the study was to describe patterns of overlap between public and privately organized healthcare utilization, and not to examine the underlying reasons for choosing one or the other.\u003c/p\u003e \u003cp\u003eAnother potential limitation is the use of a binary measure of healthcare utilisation (having at least one contact during each period) rather than, for example, the number or proportion of contacts in privately organized healthcare. This approach was chosen to capture whether people utilised more than one type of healthcare provider within the system. Nevertheless, it limits conclusions regarding the intensity or frequency of healthcare utilization. In addition, the pre-pandemic and pandemic periods differed in length, which restricts direct comparisons of utilisation levels between periods. However, as the analyses focused on differences between cohorts within each period rather than changes over time within cohorts, this discrepancy is unlikely to have materially affected the results.\u003c/p\u003e \u003cp\u003eOnly physical healthcare contacts were included while telephone and video contacts were not. This is likely to have had the greatest impact during the pandemic period, when the use of digital consultations increased. We have previously reported that during the pandemic, people with intellectual disabilities were more likely than the general population to have video contact with specialist healthcare but less likely to have such contact with primary healthcare physicians (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). As the observed associations for the ID cohort were stronger during the pandemic period for both primary and specialist care, restricting the analyses to physical contacts is unlikely to have substantially biased the results.\u003c/p\u003e \u003cp\u003eWe would like to highlight a few of our findings. First, among people with at least one contact in privately organized healthcare, the proportion who also had at least one contact in public healthcare was high and similar in the ID and gPop cohorts, across age groups and sexes. This indicates substantial overlap in provider use, with privately organized healthcare commonly occurring alongside public healthcare. Because our analyses were restricted to physical visits to physicians, these patterns reflect physician-delivered care within these settings. When stratifying by type of public healthcare, overlap was similarly high for public primary healthcare and public somatic outpatient specialist care, although children with intellectual disabilities who used privately organized healthcare had a slightly higher likelihood of also having somatic specialist contacts. This pattern may be consistent with higher healthcare needs and more complex care pathways among children with intellectual disabilities, where privately organized healthcare alone may not cover all required services. Previous studies have reported that choice reforms can make integrated care for people with complex needs more difficult (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Future investigations should examine whether differences in overlap are explained by variations in need, service availability, or care pathways, and to what extent they reflect barriers to obtaining coordinated care.\u003c/p\u003e \u003cp\u003eSecond, psychiatric outpatient specialist care showed a distinct pattern: among people with at least one contact in privately organized healthcare, children and adults with intellectual disabilities were markedly more likely than their peers in the general population to also have contacts in public psychiatric outpatient specialist care. In other words, psychiatric specialist contacts among people using privately organized healthcare were substantially more common in the public sector for the ID cohort. One possible explanation is that psychiatric specialist care for people with intellectual disabilities may more often be delivered through established public specialist services with long-term follow-up, which could reduce the extent of psychiatric healthcare delivered by privately organised providers. Further research is needed to clarify how service organisation and continuity of care contribute to this pattern.\u003c/p\u003e \u003cp\u003eThird, among people with at least one contact in public healthcare, children in the ID cohort had similar likelihood of also having contacts in privately organized healthcare as children in the general population, whereas adults with intellectual disabilities were consistently less likely than their peers to have contacts in privately organized healthcare. This indicates lower utilisation of privately organised healthcare providers among adults with intellectual disabilities within a system that formally allows provider choice. A plausible explanation for the difference between children and adults is that healthcare contacts for children are more often initiated and managed by parents or caregivers, whereas adults may need to navigate provider options more independently or with variable support. Future studies should explore which factors are associated with the use of privately organised providers among adults with intellectual disabilities, including health status, severity of disability, sociodemographic factors, and social support, and should also investigate the observed sex differences. From a health‑system perspective, support functions that facilitate navigation and coordination, such as care coordinators, may be relevant to reduce fragmentation and help ensure that provider choice is accessible for people with intellectual disabilities. This is consistent with person‑centred care principles and with legal and organisational expectations that people should be able to make informed choices with appropriate support. Measures to improve accessibility may also include strengthening communication competence in both public and privately organised services and expanding accessible digital services and e‑health options.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings from the present study have important implications for patient‑choice‑based health systems. They indicate that formally available provider choice does not result in similar patterns of utilisation across populations. Also, that adults with intellectual disabilities may face challenges in navigating and using privately organised providers within such systems. The prominent role of public psychiatric specialist services further highlights the continued importance of publicly provided specialist care for people with intellectual disabilities. Together, the results underscore the need for patient‑choice‑based healthcare systems to be designed and implemented in ways that support accessibility, coordination, and navigation for people with intellectual disabilities, particularly adults with complex healthcare needs and during periods of healthcare disruption.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCI \u0026nbsp;Confidence interval\u003c/p\u003e\n\u003cp\u003eICD-10 \u0026nbsp;International Statistical Classification of Diseases and Related Health Problems 10th Revision\u003c/p\u003e\n\u003cp\u003eRR \u0026nbsp;Relative risk\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in accordance with the Declaration of Helsinki. Ethics approval was obtained from the Swedish Ethical Review Authority (dnr 2021\u0026thinsp;\u0026minus;\u0026thinsp;01444 with amendments 2021\u0026ndash;04910 and 2021\u0026ndash;06056). Moreover, the Swedish National Board of Health and Welfare and Statistics Sweden performed their own secrecy review before providing the data. Swedish law does not require consent to participate in register studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince the data comprise information about single people and are detailed enough to enable identification of, at least, some of the people included, they cannot be made publicly available. However, as the database was compiled from national register data, other researchers may contact the register holders to obtain access to the registries used in this study and thereby generate an identical database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study, as well as the IDcare project, was funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE, dnr 2019\u0026thinsp;\u0026minus;\u0026thinsp;00105 and 2021\u0026thinsp;\u0026minus;\u0026thinsp;01862). Open access funding was provided by Lund University. The funder played no role in the analysis, interpretation, or reporting of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: AA, MS. KE; Methodology: AA, MS. KE; Software: AA; Validation: MS; Formal analysis: AA; Investigation: AA; Resources: AA, MS; Data curation: AA; Writing \u0026ndash; original draft: AA; Writing \u0026ndash; review \u0026amp; editing: AA, MS, KE; Visualization: AA; Supervision: AA, MS; Project administration: MS; Funding acquisition: AA, MS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganisation for Economic Co-operation and Development (OECD). Competition in the provision of hospital services. 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RAND J Econ. 2021;52(2):382\u0026ndash;414.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrekke KR, Canta C, Siciliani L, Straume OR. Hospital competition in a national health service: Evidence from a patient choice reform. J Health Econ. 2021;79:102509.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang Q, Tian F, Liu Z, Pan J. Hospital Competition and Unplanned Readmission: Evidence from a Systematic Review. Risk Manag Healthc Policy. 2021;14:473\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGustafsson PE, Fonseca-Rodr\u0026iacute;guez O, San Sebasti\u0026aacute;n M, Burstr\u0026ouml;m B, Mosquera PA. Evaluating the impact of the 2010 Swedish choice reform in primary health care on avoidable hospitalization and socioeconomic inequities: an interrupted time series analysis using register data. BMC Health Serv Res. 2024;24(1):972.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFredriksson M, Isaksson D. 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Int J Equity Health. 2017;16(1):29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen VC-Y, Ward WJ, Chen L-K. Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care. Arch Gerontol Geriatr. 2019;83:263\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao P, Vajdic C, Trollor J, Reppermund S. Prevalence and incidence of physical health conditions in people with intellectual disability - a systematic review. PLoS ONE. 2021;16(8):e0256294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMazza MG, Rossetti A, Crespi G, Clerici M. Prevalence of co-occurring psychiatric disorders in adults and adolescents with intellectual disability: A systematic review and meta-analysis. J Appl Res Intellect Disabil. 2020;33(2):126\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorner-Johnson W, Klein KA, Campbell J, Guise JM. It Would Have Been Nice to Have a Choice: Barriers to Contraceptive Decision-making among Women with Disabilities. Womens Health Issues. 2022;32(3):261\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheehan R, Hassiotis A, Strydom A, Morant N. Experiences of psychotropic medication use and decision-making for adults with intellectual disability: a multistakeholder qualitative study in the UK. BMJ Open. 2019;9(11):e032861.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheerin J, Larkin F, Dockray S. Perceptions of People With Intellectual Disabilities on Autonomy and Decision-Making in Daily Life: A Systematic Review and Synthesis of Qualitative Studies. J Intellect Disabil Res. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVallury KD, Tucker V, Sheeran N. Contraceptive and Pregnancy Decision-Making Autonomy and Health Care Experiences Among Women With Intellectual Disabilities. J Intellect Disabil Res. 2025;69(4):274\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCasey H, Trayer \u0026Aacute;, Desmond D, Coffey L. Experiences and perceptions of everyday decision-making in the lives of adults with intellectual disabilities, their care partners and direct care support workers. J Intellect Disabil. 2025;29(3):683\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoorlandt HW, Korfage IJ, Tuffrey-Wijne I, Festen D, Vrijmoeth C, van der Heide A, et al. Consensus on a conversation aid for shared decision making with people with intellectual disabilities in the palliative phase. J Appl Res Intellect. 2021;34(6):1538\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHutchinson C, Milte R, Stanley M, Duff G, Ratcliffe J. Using discrete choice experiments to elicit the service preferences of people with mild intellectual disability: An exploratory study. Health Soc Care Community. 2022;30(4):e1396\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDowns J, Keeley J, Skoss R, Mills J, Nevill T, Schippers A, et al. Perspectives on the essential skills of healthcare decision making in children and adolescents with intellectual disability. Int J Equity Health. 2024;23(1):119.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobitaille MJ, Gauthier-Boudreault C, Rochon V. How can we support people with profound intellectual and multiple disabilities in enhancing their self-determination? A scoping review. J Intellect Dev Disabil. 2025:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkarsaune SN. Self-determination of people with profound intellectual and multiple disabilities. Dev Med Child Neurol. 2023;65(1):16\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKomenda-Schned S, Landskron SJ, Moritz P, Braunstein N, Hochmeister J, Riegler K, et al. Good mental health for people with intellectual disabilities: a participatory focus group study. Int J Equity Health. 2025;24(1):180.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKomenda-Schned S, Moritz P, Landskron SJ, Herscovici AR, Schomburg C, Lehner J, et al. Exploring good mental health for people with intellectual disabilities: a qualitative interview study with mental health experts. Int J Equity Health. 2025;24(1):172.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWehmeyer ML. The Importance of Self-Determination to the Quality of Life of People with Intellectual Disability: A Perspective. Int J Environ Res Public Health. 2020;17:19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWehmeyer ML. Self-determination in adolescents and adults with intellectual and developmental disabilities. Curr Opin Psychiatry. 2020;33(2):81\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Swedish National Board of Health and Welfare. Analys av f\u0026ouml;rsta och andra covid-19-v\u0026aring;gen - produktion, k\u0026ouml;er och v\u0026auml;ntetider i v\u0026aring;rden. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAxmon A, Kristensson J, Sandberg M. Pre-pandemic and pandemic healthcare utilization among older people with intellectual disabilities compared to the general population (IDcare). J Public Health. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRegion Sk\u0026aring;ne, \u0026Ouml;ppenv\u0026aring;rd. Region Sk\u0026aring;ne; 2025 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://vardgivare.skane.se/patientadministration/avgifter-och-prislistor/patientavgifter/besok-annan-personal/\u003c/span\u003e\u003cspan address=\"https://vardgivare.skane.se/patientadministration/avgifter-och-prislistor/patientavgifter/besok-annan-personal/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRegion Sk\u0026aring;ne. H\u0026ouml;gkostnadsskydd och frikort: Region Sk\u0026aring;ne. 2025 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://vardgivare.skane.se/patientadministration/avgifter-och-prislistor/patientavgifter/hogkostnadsskydd-frikort/\u003c/span\u003e\u003cspan address=\"https://vardgivare.skane.se/patientadministration/avgifter-och-prislistor/patientavgifter/hogkostnadsskydd-frikort/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAct on System of Choice in the Public Sector [In Swedish: Lag om valfrihetssystem]. (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSveriges Kommuner och Regioner. Regionen i siffror 2025. En beskrivning av regionernas verksamhet och ekonomi. Sveriges Kommuner och Regioner; 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanl\u0026ouml;v N, Merkur S, Sweden. Health System Summary, 2024. Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanl\u0026ouml;v N, Blume S, Glenng\u0026aring;rd A, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Syst Transition. 2023;25(4):i\u0026ndash;198.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandberg M, Kristensson J, Axmon A. IDcare - a longitudinal register study of pre-pandemic and pandemic health care utilization and diagnostic profiles among people with intellectual disabilities in southern Sweden. Eur J Epidemiol. 2024;39(9):1063\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandberg M, Chadwick D, Axmon A, editors. Digital healthcare utilization during the COVID-19 pandemic among people with intellectual disabilities compared to the general population (IDcare). Munich: IASSIDD Europe; 2026.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient involvement, private healthcare providers, intellectual disability, register study, primary healthcare, specialist care, health services accessibility","lastPublishedDoi":"10.21203/rs.3.rs-9263449/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9263449/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePeople with intellectual disabilities often have complex healthcare needs and may therefore experience different patterns of healthcare utilization within such systems. This study examined the overlap between the use of public and private healthcare providers as an indicator of access to choice-enabled healthcare providers within a patient-choice-based health system.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe assessed overlap in two complementary ways: among people with at least one private healthcare contact and among those with at least one public healthcare contact in a cohort of people with intellectual disability (ID cohort) and a referent cohort from the general population (gPop cohort). The ID cohort comprised 2 813 children and 9 079 adults, whereas the gPop cohort comprised 146 048 children and 982 186 adults. Data regarding healthcare contacts in public and privately organized healthcare were collected from the Sk\u0026aring;ne Healthcare Register.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong those with at least one contact in privately organized healthcare, both children and adults with intellectual disabilities were as likely as those in the general population to also have contacts in public primary healthcare and public somatic specialist care. However, they were more likely to have contacts in public psychiatric specialist care. Among those with at least one contact in public healthcare, children with intellectual disabilities were as likely as their age peers in the general population to also have contacts in privately organized healthcare. However, adults with intellectual disabilities were less likely than their age peers to have contacts in privately organized healthcare.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings have important implications for patient‑choice‑based health systems. They indicate that formally available provider choice does not result in similar patterns of utilisation across populations. Also, that adults with intellectual disabilities may face challenges in navigating and using privately organised providers within such systems. The prominent role of public psychiatric specialist services further highlights the continued importance of publicly provided specialist care for this group. Together, the results underscore the need for patient‑choice‑based healthcare systems to be designed and implemented in ways that support accessibility, coordination, and navigation for people with intellectual disabilities, particularly adults with complex healthcare needs and during periods of healthcare disruption.\u003c/p\u003e","manuscriptTitle":"Access to choice‑enabled healthcare providers among children and adults with intellectual disabilities in comparison with the general population (IDcare)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-16 09:59:25","doi":"10.21203/rs.3.rs-9263449/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-13T12:23:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T15:01:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260038776169717387072632708948149734662","date":"2026-05-02T21:16:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T08:46:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114267966111165250304153778878682364004","date":"2026-04-09T04:54:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-08T17:27:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-06T17:19:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T01:48:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T01:47:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-30T06:57:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"780d1649-861c-4d9f-9f44-d9f2527acdb5","owner":[],"postedDate":"April 16th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-13T12:23:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-12T15:01:24+00:00","index":64,"fulltext":""},{"type":"reviewerAgreed","content":"260038776169717387072632708948149734662","date":"2026-05-02T21:16:15+00:00","index":61,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T12:39:43+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-16 09:59:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9263449","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9263449","identity":"rs-9263449","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}