| 1. |
- Vengberg, Sofie, et al.
(författare)
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Money matters : primary care providers' perceptions of payment incentives
- 2021
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 35:4, s. 458-474
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work. Design/methodology/approach An interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjusted capitation payments, and the other a mainly risk-adjusted capitation system. Findings Findings suggested that both managers and salaried physicians were aware of and adapted to unit-level payment incentives, albeit the latter sometimes to a lesser extent. Respondents perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits and skimming of healthier patients. Results also suggested that differentiated rates for patient visits affected horizontal prioritisations between physician and nurse visits. Respondents perceived that risk-adjustments for diagnoses led to a focus on registering diagnosis codes, and to some extent, also up-coding of secondary diagnoses. Practical implications Policymakers and responsible authorities need to design payment systems carefully, balancing different incentives and considering how and from where data used to calculate payments are retrieved, not relying too heavily on data supplied by providers. Originality/value This study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.
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| 2. |
- Hao, Shuang, et al.
(författare)
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Influence of elicitation procedure and phrasing on health state valuations in experience-based time trade-off tasks among diabetes patients in China
- 2020
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Ingår i: Quality of Life Research. - : SPRINGER. - 0962-9343 .- 1573-2649. ; 29:1, s. 289-301
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Open-ended and iteration-based time trade-off (TTO) tasks can both be used for valuation of health states. It has so far not been examined how the elicitation procedure affects the valuation of experience-based health states. The purpose of this study is to investigate the influence of elicitation procedure on experience-based health state values elicited by the TTO method. Methods 156 Chinese adults with type 2 diabetes participated in face-to-face interviews with an open-ended or an iteration-based TTO task. The association between the type of TTO task and the valuation of health states was investigated through multiple linear regression analyses. A modified open-ended TTO task was also developed (n = 33) to test whether different phrasings of open-ended TTO tasks influence TTO values. Results Higher TTO values were observed in the original open-ended TTO task compared to the iteration-based task, which indicates that the elicitation procedure influences the valuation of health states. When the modified open-ended task was introduced, the difference between the two elicitation procedures was no longer statistically significant, suggesting that the phrasing and/or visual presentation of the TTO task may influence the valuation of health states. Conclusions The choice of elicitation procedure as well as the description of experience-based TTO tasks may influence the valuation of health states. Further research is warranted, also in other cultural contexts, to further explore these findings.
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| 3. |
- Islam, M. Kamrul, et al.
(författare)
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Does income-related health inequality change as the population ages? Evidence from Swedish panel data
- 2010
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Ingår i: Health Economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 19:3, s. 334-349
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Tidskriftsartikel (refereegranskat)abstract
- This paper explains and empirically assesses the channels through which Population aging may impact on income-related health inequality. Long panel data of Swedish individuals is used to estimate the observed trend in income-related health inequality, measures by the concentration index (CI). A decomposition procedure based on a fixed effects model is used to clarify the channels by which population aging affects health inequality. Based on current income rankings, we find that conventional unstandardized and age-gender-standardized CIs increase over time. This trend in CIs is, however, found to remain stable when people are instead ranked according to lifetime (mean) income. Decomposition analyses show that two channels are responsible for the upward trend in unstandardized CIs - retired people dropped in relative income ranking and the coefficient of variation of health increases as the population ages. Copyright (C) 2009 John Wiley & Sons, Ltd.
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| 4. |
- Rehnberg, Clas, et al.
(författare)
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Deteriorating health status in Stockholm 1998-2002: results from repeated population surveys using the EQ-5D
- 2007
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Ingår i: Quality of life research. - : Springer Nature. - 1573-2649 .- 0962-9343. ; 16:9, s. 1547-1553
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aim and methodology In order to measure the change in health status in Sweden, the generic health-related quality of life instrument, the EQ-5D, was included in the 1998 (n = 4,950) and 2002 (n = 49,914) cross-sectional postal Public Health Surveys, a representative sample (21-84 years) of the Stockholm County population, with response rates about 63% in both years. The EQ-5D provides data on five dimensions of health as well as an overall index value (1 = full health; 0 = dead). Results Over time the health index decreased statistically significantly from 0.858 to 0.841 for men and from 0.833 to 0.797 for women. Women had significantly more health problems in 2002 in four out of the five dimensions, with the largest increase in the dimensions anxiety/depression (33-43%) and pain/discomfort (47-53%). The health index was significantly lower in all age-groups for women. Men had significantly more health problems 2002 in two dimensions, and the largest increase in anxiety/depression (24-31%). The health index decreased significantly over time for younger men. Conclusion The observed deterioration in health status over time gives reason for concern. Investigation of reasons for the declining health status should be a research priority.
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| 5. |
- Sparring, Vibeke, et al.
(författare)
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Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15-34 years - a Swedish population-based study using EQ-5D
- 2013
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 13, s. 377-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Diabetes with onset in younger ages affects both length of life and health status due to debilitating and life-threatening long-term complications. In addition, episodes and fear of hypoglycaemia and of long-term consequences may have a substantial impact on health status. This study aims to describe and analyse health-related quality of life (HRQoL) in individuals with onset of diabetes at the age of 15-34 years and with a disease duration of 1, 8, 15 and 24 years compared with control individuals matched for age, sex and county of residence. Methods: Cross-sectional study of 839 individuals with diabetes and 1564 control individuals. Data on socioeconomic status and HRQoL using EQ-5D were collected by a postal questionnaire. Insulin treatment was self-reported by 94% of the patients, the majority most likely being type 1. Results: Individuals with diabetes reported lower HRQoL, with a significantly lower mean EQ VAS score in all cohorts of disease duration compared with control individuals for both men and women, and with a significantly lower EQ-5D(index) for women, but not for men, 15 years (0.76, p = 0.022) and 24 years (0.77, p = 0.016) after diagnosis compared with corresponding control individuals. Newly diagnosed individuals with diabetes reported significantly more problems compared with the control individuals in the dimension usual activities (women: 13.2% vs. 4.0%, p = 0.048; men: 11.4% vs. 4.1%, p = 0.033). In the other dimensions, differences between individuals with diabetes and control individuals were found 15 and 24 years after diagnosis: for women in the dimensions mobility, self-care, usual activities and pain/discomfort and for men in the dimension mobility. Multivariable regression analysis showed that diabetes duration, being a woman, having a lower education and not being married or cohabiting had a negative impact on HRQoL. Conclusions: Our study confirms the negative impact of diabetes on HRQoL and that the difference to control individuals increased by disease duration for women with diabetes. The small difference one year after diagnosis could imply a good management of diabetes care and a relatively quick adaptation. Our results also indicate that gender differences still exist in Sweden, despite modern diabetes treatment and management in Sweden.
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| 6. |
- Wastesson, Jonas W., et al.
(författare)
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Regional variations in excessive polypharmacy and potentially inappropriate drug use among older adults in Sweden : Trends from 2006 to 2020
- 2023
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Ingår i: Frontiers in Pharmacology. - : Frontiers Media SA. - 1663-9812. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Potentially inappropriate drug use (PID) is common among older adults. Cross-sectional data suggest that there are marked regional variations in PID in Sweden. There is, however, a lack of knowledge about how the regional variations have changed over time.Objectives: This study aimed to investigate the regional differences in the prevalence of PID in Sweden, 2006-2020.Methods: In this repeated cross-sectional study, we included all older adults (>= 75 years) registered in Sweden, yearly from 2006 to 2020. We used nationwide data from the Swedish Prescribed Drug Register linked at the individual level to the Swedish Total Population Register. We selected three indicators of PID according to the Swedish national Quality indicators for good drug therapy in the elderly : 1) Excessive polypharmacy (use of >= 10 drugs); 2) Concurrent use of three or more psychotropic drugs; 3) Use of drugs that should be avoided in older adults unless specific reasons exist. The prevalence of these indicators was calculated for each of Sweden's 21 regions, yearly from 2006 to 2020. The annual coefficient of variation (CV) was calculated for each indicator by dividing the standard deviation of the regions by the national average, to measure relative variability.Results: In the population of about 800,000 older adults per year, the national prevalence of drugs that should be avoided in older adults, was reduced by 59% from 2006 to 2020. There was a slight decline in the use of three or more psychotropics, while the prevalence of excessive polypharmacy increased. The CV for excessive polypharmacy was 14% in 2006 and 9% in 2020 compared to 18% and 14% for use of three or more psychotropics , and stable at around 10% for 'drugs that should be avoided in older adults.' Conclusions:The regional variation in potentially inappropriate drug use decreased or were stable from 2006 to 2020. The regional differences were largest for the use of three or more psychotropics. We found a general tendency that regions with a good performance at the start of the period performed well across the entire period. Future studies should investigate the reasons for regional variation and explore strategies to reduce unwarranted differences.
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| 7. |
- Zhuo, Lang, et al.
(författare)
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Time Trade-Off Value Set for EQ-5D-3L Based on a Nationally Representative Chinese Population Survey
- 2018
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 21:11, s. 1330-1337
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To obtain a nationally representative Chinese three-level EuroQol five-dimensional questionnaire value set based on the time trade-off (TTO) method.Methods: A multistage, stratified, clustered random nationally representative Chinese sample was used. The study design followed an adapted UK Measurement and Valuation of Health protocol. Each respondent valued 11 random states plus state 33333 and "unconscious" using the TTO method in face-to-face interviews. Three types of models were explored: ordinary least squares, general least squares, and weighted least squares models.Results: In total, 5939 inhabitants aged 15 years and older were interviewed. Of these, 5503 satisfactorily interviewed participants were included in constructing models. An ordinary least squares model including 10 dummies without constant and N3 had a mean absolute error of 0.083 and a correlation coefficient of 0.899 between the predicted and mean values. Goodness-of-fit indices of two models based on split subsample were similar.Conclusions: TTO values were higher in our study compared with those in a study carried out in urban areas, which is mirrored by the higher values in rural areas. Several other aspects, in addition to the valuation procedure, might have influenced the results, such as factors beyond demographic factors such as view on life and death and believing in an afterlife, which need further investigation. Future studies using the three-level EuroQol five-dimensional questionnaire should consider using this value set based on a nationally representative sample of the Chinese population.
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