1.
Castor, Charlotte, et al.
(författare)
Healthcare costs and productivity losses associated with county-based home-care service for sick children in Sweden
2020
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 34:4, s. 1054-1062
Tidskriftsartikel (refereegranskat) abstract
© 2020 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science Aims: The aim of this study was to estimate the healthcare costs and productivity losses associated with county-based home-care services (HCS) for sick children. Methods: In this observational follow-up study, a combination of hospital care and HCS was compared to estimated alternative care solely at the hospital. Data on one year of healthcare utilisation for 32 children, supplied by the hospital and HCS, were collected from administrative systems. Corresponding healthcare unit prices were collected from healthcare pricelists. The human-capital approach was applied to estimate productivity losses and the value of productivity losses for 25 parents. Family characteristics, including parental work absenteeism and income, were collected by a questionnaire distributed to parents at five time points during a year. Descriptive and comparative statistics were used for analysis and carried out with ethical approval. Results: Healthcare costs for children receiving a combination of hospital care and HCS varied among children with estimated average healthcare cost savings of SEK 50101 per child compared to the alternative of care provided only in the hospital. The reduced costs were related to children receiving nonpalliative HCS care tasks. Average annual productivity losses due to parental work absenteeism were estimated at 348hours with an associated monetary value estimated at SEK 137524 per parent. Conclusion: County-based HCS, provided as complement to and substitute for hospital care for ill children, does not increase healthcare cost and should be a prioritized area when organising paediatric health care. Productivity losses vary greatly among parents and are pronounced also when children receive HCS with signs of gender-related differences.
2.
Bolin, Kristian, et al.
(författare)
The family as the health producer--when spouses act strategically.
2002
Ingår i: Journal of Health Economics. - 1879-1646. ; 21:3, s. 475-495
Tidskriftsartikel (refereegranskat) abstract
The Grossman model has been extended recently in order to take account of the fact that most people lead their lives in a family--using frameworks in which family members, respectively, (a) have common preferences and (b) are Nash-bargainers. These models, however, do not consider individual incentives for behaving strategically. In the model presented in this paper, spouses interact strategically both in the production of own health and in the production of health of other family members. We analyse, inter alia, the impact on the distribution of health of changes in family policies, such as child allowance and custody rules.
3.
Wennick, Anne, et al.
(författare)
Attained education and self-assessed health later in life when diagnosed with diabetes in childhood : a population-based study
2011
Ingår i: Pediatric Diabetes. - : Wiley-Blackwell. - 1399-543X .- 1399-5448. ; 12:7, s. 619-626
Tidskriftsartikel (refereegranskat) abstract
Background: Previous studies have reported conflicting findings on academic achievement in children with type 1 diabetes, and generally lower self-assessed health status among respondents with diabetes. Objective: Thus, in this study, using the theoretical framework of the human-capital model, a population-based survey data set for Sweden, and explanatory variables following predictions from theory and previous empirical human-capital studies, individuals diagnosed with diabetes before the age of 19 were examined whether they differ from the general population at the same age concerning (i) educational level attained and (ii) self-assessed health later in life. Special attention was devoted to the association between education and health. Subjects: A set of pooled cross-sectional population survey data complemented with register data, comprising 20 670 individuals (of whom 106 individuals were diagnosed with diabetes), aged 19–38 yr, from 1988 to 2000, was created from the Swedish Biennial Survey of Living Conditions. Method: The influence of childhood diabetes was analyzed using multiple regression analysis, controlling for educational level, wage, sex, age, marital status, and parental ethnicity. Results: Childhood diabetes was associated with lower levels of attained education and self-assessed health in comparison with the general population. More educated individuals reported better health, though. Conclusions: In terms of the rapid increase in the incidence of diabetes in many countries, it is important to bear in mind that investments made both in education and in health, early in life, may facilitate the capability of the individual to experience healthy time later in life.
4.
Pirhonen, Laura, et al.
(författare)
Effects of person-centred care on health outcomes—A randomized controlled trial in patients with acute coronary syndrome
2017
Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 121:2, s. 169-179
Tidskriftsartikel (refereegranskat) abstract
© 2016 Elsevier Ireland LtdObjectives To study the effects of person-centred care provided to patients with acute coronary syndrome, using four different health-related outcome measures. Also, to examine the performance of these outcomes when measuring person-centred care. Data and method The data used in this study consists of primary data from a multicentre randomized parallel group, controlled intervention study for patients with acute coronary syndrome at Sahlgrenska University Hospital in Gothenburg, Sweden. The intervention and control group consisted of 94 and 105 patients, respectively. The effect of the intervention on health-related outcomes was estimated, controlling for socio-economic and disease-related variables. Results Patients in the intervention group reported significantly higher general self-efficacy than those in the control group six months after intervention start-up. Moreover, the intervention group returned to work in a greater extent than controls; their physical activity level had increased more and they had a higher EQ-5D score, meaning higher health-related quality of life. These latter effects are not significant but are all pointing towards the beneficial effects of person-centred care. All the effects were estimated while controlling for important socio-economic and disease-related variables. Conclusion The effectiveness of person-centred care varies between different outcomes considered. A statistically significant beneficial effect was found for one of the four outcome measures (self-efficacy). The other measures all captured beneficial, but not significant, effects.
5.
Bolin, Kristian, et al.
(författare)
Employer investments in employee health - Implications for the family as health producer
2002
Ingår i: Journal of Health Economics. - 1879-1646. ; 21:4, s. 563-583
Tidskriftsartikel (refereegranskat) abstract
The model presented in this paper further extends the demand-for-health model in which the family is the producer of health investments, to consider the case in which an employer has incentives for investing in the health of a family member. The household and the employer are assumed to interact strategically in the production of health. The general insight provided is that the conditions which determine the nature of the relationship between the employer and the employee, for instance market conditions, production technologies, taxes, and government regulation, will also affect the allocation of health investments and health capital within the family. (C) 2002 Elsevier Science B.V. All rights reserved.
6.
Barbieri, Paolo Nicola, et al.
(författare)
Digitalizing and collecting health data in Sweden
2018
Ingår i: Pharmaceuticals Policy and Law. - 1389-2827. ; 19:3-4, s. 235-245
Tidskriftsartikel (refereegranskat) abstract
The use of information technology (IT) in health care has the potential to facilitate care over distance in almost any clinical specialties, reducing time to diagnosis, improve equity of access for patients in remote areas, and improve quality of life and patient satisfaction. In particular, electronic health records (EHRs) offer the possibility of accessing fast and updated patients' information. With the potential of making easier for individuals to be more concern in their own health and care, by increasing contact between individuals and health care providers; but also by providing more efficient support systems for medical staff. In this paper, we present the Swedish current experience and future development in the use of EHRs, in order draw upon such example to apply this methodology for data sharing and collection in other European countries. © 2017 – Network of Centres for Study of Pharmaceutical Law. All rights reserved.
7.
Pirhonen, Laura, et al.
(författare)
Person-Centred Care in Patients with Acute Coronary Syndrome: Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial.
2019
Ingår i: PharmacoEconomics - open. - : Springer Science and Business Media LLC. - 2509-4254 .- 2509-4262. ; 3:4, s. 495-504
Tidskriftsartikel (refereegranskat) abstract
Costs associated with an ACS incident are most pronounced in the acute phase but are also considerably long after the initial hospitalisation, partly due to considerable productivity losses, which constitute a substantial part of the economic burden of the disease. Studies suggest that person-centred care may improve health-related quality of life and reduce the costs associated with the disease.The aim of this study was to calculate the cost-effectiveness of a person-centred care intervention compared with usual care in patients with acute coronary syndrome (ACS), in a Swedish setting.Primary data from a randomised controlled trial of a person-centred intervention in patients with ACS was used. The person-centred intervention involved co-creation of a health plan between the patient and healthcare professionals, based on the patient's narrative. Thereafter, goals for the recovery period were set and followed-up continuously throughout the intervention. The clinical data, collected during the randomised controlled trial, was complemented with data from national health registers and the Swedish Social Insurance Agency. The study was conducted at two hospitals situated in a Swedish municipality. Patients were enrolled between June 2011 and February 2014 (192 patients were included in this study; 89 in the intervention group and 103 in the control group). Incremental cost-effectiveness ratios were calculated separately for the age groups<65years and≥65years in order to account for the age of retirement in Sweden. The cost-effectiveness ratios were calculated using health-related quality of life (EQ-5D) and costs associated with healthcare and pharmaceutical utilisation, and productivity losses.Treatment effects and costs differed between those below and those above the age of 65years. The base-case calculations showed that person-centred care was more effective and less costly compared with usual care for patients under 65years of age, while usual care was more effective and less costly in the older age group. Probabilistic sensitivity analyses resulted in a 90% likelihood that person-centred care is cost-effective compared with usual care for patients with ACS under the age of 65years.Person-centred care was found to be cost-effective compared with usual care for patients with acute coronary syndrome under the age of 65years. This clinical trial is registered at Researchweb (ID 65791).
8.
Bolin, Kristian, et al.
(författare)
Informal and formal care among single-living elderly in Europe.
2008
Ingår i: Health Economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 17:3, s. 393-409
Tidskriftsartikel (refereegranskat) abstract
The aims of this study were to analyse (1) whether informal care, provided by children or grandchildren to their elderly parents, and formal care are substitutes or complements, and (2) whether this relationship differs across Europe. The analyses Were based on cross-sectional data from the newly developed SHARE (Survey of Health, Ageing, and Retirement in Europe) database. We found (1) that informal and formal home care are substitutes, while informal care is a complement to doctor and hospital visits, and (2) that these relationships in some cases differ according to a European north-south gradient. Instrumental variable methods were used and the results highlight the importance of accounting for the endogeneity of informal care.
9.
Bolin, Kristian, et al.
(författare)
Non-life-threatening ailments and rational patience when expected treatment outcomes are continuously improving
2021
Ingår i: Journal of Health Economics. - : Elsevier BV. - 0167-6296 .- 1879-1646. ; 79
Tidskriftsartikel (refereegranskat) abstract
The time at which a rational patient chooses to undergo an elective medical procedure for a non-life-threatening ailment is contemplated. The resulting model is purposely uncomplicated but general, and accounts for several basic factors that might affect such a decision. One such factor is that a patient cannot know with certainty the degree to which the medical procedure will be successful. Even so, patients have information about the expected outcome of the procedure and its risk, and about how the expected outcome and risk are affected by medical technological progress and surgeon experience. The effect of changes in exogenous variables on the timing of the medical procedure and on patient expected lifetime utility are investigated. It is shown that risk averse and prudent patients behave in an unambiguous manner in response to changes in all of the exogenous variables.
10.
Mathiassen, Svend Erik, et al.
(författare)
Optimizing cost-efficiency in mean exposure assessment – cost functions reconsidered
2011
Ingår i: BMC Medical Research Methodology. - : Springer Science and Business Media LLC. - 1471-2288. ; 11:76
Tidskriftsartikel (refereegranskat) abstract
Background. Reliable exposure data is a vital concern in medical epidemiology and intervention studies. The present study addresses the needs of the medical researcher to spend monetary resources devoted to exposure assessment with an optimal cost-efficiency, i.e. obtain the best possible statistical performance at a specified budget. A few previous studies have suggested mathematical optimization procedures based on very simple cost models; this study extends the methodology to cover even non-linear cost scenarios. Methods. Statistical performance, i.e. efficiency, was assessed in terms of the precision of an exposure mean value, as determined in a hierarchical, nested measurement model with three stages. Total costs were assessed using a corresponding three-stage cost model, allowing costs at each stage to vary non-linearly with the number of measurements, according to a power function. Using these models, procedures for identifying the optimally cost-efficient allocation of measurements under a constrained budget were developed, and applied on 225 scenarios combining different sizes of unit costs, cost function exponents, and exposure variance components. Results. Explicit mathematical rules for identifying optimal allocation could be developed when cost functions were linear, while non-linear cost functions implied that parts of or the entire optimization procedure had to be carried out using numerical methods. For many of the 225 scenarios, the optimal strategy consisted in measuring on one occasion from each of as many subjects as allowed by the budget. Significant deviations from this principle occurred if costs for recruiting subjects were large compared to costs for setting up measurement occasions, and, at the same time, the between-subjects to within-subject variance ratio was small. In these cases, non-linearities had a profound influence on the optimal allocation and on the eventual size of the exposure data set. Conclusions. The analysis procedures developed in the present study can be used for informed design of exposure assessment strategies, provided that data are available on exposure variability and the costs of collecting and processing data. The present shortage of empirical evidence on costs and appropriate cost functions however impedes general conclusions on optimal exposure measurement strategies in different epidemiologic scenarios.
