| 1. |
- Dackehag, Margareta, et al.
(författare)
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Day-to-Day Living Expenses and Mental Health
- 2016
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- We use rich longitudinal survey and register data on Swedish individuals to examine the relationship between financial strain and mental health. Specifically, we consider the longitudinal relationships between payment difficulties and subjective (self-reported anxiety) as well as objective (psychiatric drug use) measures of mental ill-health. Among previously healthy individuals, payment difficulty experiences are strongly associated with self-reported mental ill-health. The association with later psychiatric drug use is weaker and differs by gender. Psychiatric drug users are on the other hand at high risk of later experiencing payment difficulties. This indicates that policy measures regarding the payment difficulties–health nexus ought to prioritize activities improving mental health.
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| 2. |
- Ellegård, Lina Maria, et al.
(författare)
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An App Call a Day Keeps the Patient Away? Substitution of Online and In-Person Doctor Consultations Among Young Adults
- 2021
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The emergence of markets for online physician consultations -- direct-to-consumers telemedicine (DCT) -- is transforming healthcare services in many nations. The convenience of DCT lowers the cost of seeking care, thus potentially increasing demand. Yet, it is not known whether patients consuming online care turn to traditional providers as well. This is one of the first studies to causally assess to which degree online physician consultations substitute for in-person consultations. We exploit the rapid emergence of a DCT market and exogenous changes in patient fees in a fuzzy difference-in-discontinuities analysis of young adults in two Swedish regions. We find evidence in support of partial substitution and an increase in total physician consultations.
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| 3. |
- Dietrichson, Jens, et al.
(författare)
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Patient Choice, Entry, and the Quality of Primary Care: Evidence from Swedish Reforms
- 2016
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Policies aimed to spur quality competition among health care providers are ubiquitous, but their impact on quality is ex ante ambiguous. This study contributes to the sparse empirical literature on primary care quality by examining the heterogeneous impact of recent competition enhancing reforms in Sweden. The reforms led to substantially more entry of new providers in more exposed markets, but the effects on primary care quality in these markets were modest: we find small improvements of patients' overall satisfaction with care, but no consistently significant effects on avoidable hospitalization rates or satisfaction with access to care.
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| 4. |
- Dackehag, Margareta, et al.
(författare)
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Social Assistance and Mental Health: Evidence from Longitudinal Data on Pharmaceutical Consumption
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper examines the short-term effect between take-up of Social Assistance Benefit (SAB) and mental health. Using a panel dataset including rich yearly register data on e.g. income, income sources, unemployment and types of pharmaceutical consumption for over 140,000 Swedes 2006-2012, we quantify the importance of the psychosocial dimensions (e.g. shame and guilt) of the socioeconomic status – mental health nexus. Our main independent variable is an indicator for SAB, which is the means-tested last-resort option for individuals with no other means to cover necessary living expenses, received by six per cent of all Swedish households annually. Mental ill-health is measured by data on prescribed antidepressants, anxiolytics, or hypnotics. While SAB strongly associates with psychopharmaca consumption in a cross-section of observations, the association largely disappear once we introduce individual fixed effects. These results indicate that other mechanisms than shame or guilt related to the SAB experience are more important for mental health in the short term.
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| 5. |
- Andersson, Tommy, et al.
(författare)
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Multiple Pricing for Personal Assistance Services
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper provides a general theoretical framework that captures the essential features ofa Swedish reform where private and public health care providers serve patients with certainfunctional impairments. Because providers receive a fixed hourly compensation for theirservices (identical across patient types) and only private providers can reject service requestsfrom patients, private providers avoid the costliest patients, resulting in a monetary deficitfor public providers. To partially overcome this problem, a multiple pricing (reimbursement)scheme is proposed and its solution is characterized. The results suggest that there are somefundamental trade-offs, e.g., between the goals of containing costs and restricting choicesfor patients, but that the suggested pricing scheme may substantially reduce the deficits forpublic providers without affecting the total budget set by the central government.
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| 6. |
- Anell, Anders, et al.
(författare)
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Better Off by Risk Adjustment? Socioeconomic Disparities in Care Utilization in Sweden Following a Payment Reform
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Reducing socioeconomic health inequalities is a key goal of most health systems. When care providers are paid prospectively, e.g., by a fixed sum per patient, existing inequalities may be sustained by the incentives to undertreat relatively unhealthy patients. To counter these incentives, prospective payments are often risk-adjusted based on observable patient characteristics. Despite that risk adjustment (RA) is widely used, empirical evidence is lacking on how it affects the behavior of care providers. This paper provides such evidence using detailed administrative data from a Swedish region. We examine how a novel RA model applied to the prospective payment for primary care providers – capitation – affected socioeconomic differences in care utilization among individuals with a chronic condition. On average, the new RA model implied substantial increases of the capitation for patients with low socioeconomic status (SES). Yet, we do not find any robust evidence of greater access to primary care for individuals with low SES relative to individuals with high SES after the model was introduced. We find a small increase in hospital emergency department visits (a substitute to primary care), but no effects on hospitalizations. These results do not suggest that the new RA model reduced socioeconomic health inequalities. Our findings highlight that a risk-adjusted prospective payment may not by itself guide treatment decisions. We discuss other governance and management policies that may address undesired health inequalities.
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| 7. |
- Anell, Anders, et al.
(författare)
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Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?
- 2015
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Resistance to antibiotics is a major threat to the effectiveness of modern health care. This study examines if pay-for-performance (P4P) to care providers stimulates the appropriate use of antibiotics; in particular, if P4P can induce a substitution away from broad-spectrum antibiotics, which contribute more to the development of resistance, to less resistance-driving types. In the context of Swedish primary care, we study the introduction of P4P indicators encouraging substitution of narrow-spectrum antibiotics for broad-spectrum antibiotics in the treatment of children with respiratory tract infections (RTI). During 2006-2013, 8 out of 21 county councils introduced such P4P indicators in their reimbursement schemes for primary care providers. We employ municipality-level register data covering all purchases of RTI related antibiotics and exploit the staggered introduction of pay-for-performance in a difference-in-differences analysis. Despite that the monetary incentives were small, we find that P4P significantly increased narrow-spectrum antibiotics' share of RTI antibiotics consumption. We further find larger effects in areas where there were many private providers, where the incentive was formulated as a penalty rather than a reward, and where all providers were close to a P4P target.
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| 8. |
- Anell, Anders, et al.
(författare)
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Well-Informed Choices? Effects of Information Interventions in Primary Care on Care Quality
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Market frictions, such as imperfect information or hassle costs, may reduce benefits from market incentives in healthcare settings. We use data from two randomised policy interventions in a Swedish region, which improved the access to provider information and reduced the switching costs of one percent of the adult population and of a sample of new residents. We examine the effects of the interventions on a large number of clinical process quality measures, access to care, and adverse health events, measured at the individual level. We find no significant effect of the interventions on any of the quality measures.
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| 9. |
- Dietrichson, Jens, et al.
(författare)
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Assist or desist? Conditional bailouts and fiscal discipline in local governments
- 2012
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Central government bailouts of local governments are commonly viewed as a recipe for local fiscal indiscipline, as local governments learn that the center will come to rescue in times of trouble. Little is however known about whether such tendencies can be dampened if assistance is made conditional upon the local governments' own fiscal efforts. We examine a case in which the Swedish central government provided conditional grants to 36 financially troubled municipalities: to receive the grant, municipalities first had to cut costs and balance their budgets. For each municipality, we estimate the long run program effect on per capita costs of services using the synthetic control method for case studies (Abadie and Gardeazabal, 2003; Abadie et al., 2010). The number of municipalities that substantially reduce their costs after the program is much larger than the number that substantially increase their costs, and there is a cost reducing effect on average. Fixed effects estimations with net revenues as measure of fiscal performance corroborate these findings for costs. Conditional bailouts need thus not erode fiscal responsibility and may even induce fiscal discipline.
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| 10. |
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