| 1. |
- Arrelöv, B, et al.
(författare)
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The influence of change of legislation concerning sickness absence on physicians' performance as certifiers : A population-based study
- 2003
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 63:3, s. 259-268
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, a change of the legislation for sickness absence became effective on 1st October, 1995. The purpose of the change was to reduce costs for sickness absence by exclusion of non-medical criteria for sick-listing, more part-time sick-listing and faster rehabilitation. This study was conducted in order to describe and analyse certification practice of various physician categories, before and after the change in legislation. Thirty-one thousand seven hundred and thirty certificates for sickness absence, collected by the local offices of the National Social Insurance Board in eight Swedish counties, fulfilled the inclusion criteria. The number of certificates decreased temporarily. The number of certified net days, i.e. crude days multiplied by degree, tended to increase and there was no shift from full to partial sick-listing during the period. There were small changes regarding case mix, i.e. patient characteristics, and sick-listing physician category. The results were almost unchanged when these small changes were taken into account. General practitioners issued significantly shorter periods of sick-leave than the other categories both years. The goals of the legislative change were thus not met. The result of the study indicates that other factors than the legislation may be more important for physicians' practice. ⌐ 2002 Elsevier Science Ireland Ltd. All rights reserved.
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| 2. |
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| 3. |
- Blumenschein, Karen, et al.
(författare)
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An experimental test of question framing in health state utility assessment
- 1998
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 45:3, s. 187-193
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Tidskriftsartikel (refereegranskat)abstract
- In the standard gamble and time trade-off methods of health state utility assessment, a specified health state and an alternative are compared. This alternative can be framed in terms of a loss or a gain in reference to the first health state. In this paper, we test whether this framing affects the estimated health state utilities. The experiment was carried out on a group of pharmacy students, randomly divided between the loss or gain version ( n=182). The null hypothesis of no difference between the loss and gain versions is rejected for the standard gamble method, but not for the time trade-off method.
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| 4. |
- Blumenschein, Karen, et al.
(författare)
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Incorporating quality of life changes into economic evaluations of health care: an overview
- 1996
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 36:2, s. 155-166
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Tidskriftsartikel (refereegranskat)abstract
- The demand for economic evaluations of health care programs, especially pharmaceuticals, is steadily increasing. One of the most important issues in this field is how to measure, value and incorporate changes in quality of life into the economic evaluation. We provide an overview of the different approaches to measure changes in quality of life: quality of life instruments, the quality-adjusted life-year (QALY) approach and the willingness to pay approach. Quality of life instruments have major practical advantages since they are easy to administer. The results of these instruments cannot, however, be used in economic evaluations. In economic evaluations, the quality of life has to be measured on the 0 (death) to 1 (full.health) scale necessary to construct QALYs, or the willingness to pay for the change in quality of life has to be measured. Such measurements are, however, much less straightforward to carry out. It would therefore be a major advance if it would be possible to directly translate the quality of life score into a QALY weight or the willingness to pay. It is recommended that more systematic research should be carried out on the relationship between quality of life, QALY weights, and willingness to pay.
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| 5. |
- Burström, Kristina, et al.
(författare)
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Health-related quality of life by disease and socio-economic group in the general population in Sweden
- 2001
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 55:1, s. 51-69
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Tidskriftsartikel (refereegranskat)abstract
- Measuring health-related quality of life (HRQoL) on population level, is becoming increasingly important for priority setting in health policy. In the health economics field, it is common to measure HRQoL in terms of health-state utilities or QoL weights. This study investigates the feasibility of obtaining mean QoL weights by mapping survey data to the generic HRQoL measure EQ-5D and to describe the HRQoL in terms of mean QoL weights in certain disease and socio-economic groups. Data from the 1996–1997 Survey of Living Conditions, interviews with a representative sample (16–84 years) of the Swedish population (n=11 698) were used. The mean QoL weight decreased from 0.91 among the youngest to 0.61 among the oldest, and was lower for women than for men. The QoL weight was 0.88 in the highest socio-economic group and 0.78 in the lowest socio-economic group. The QoL weight was lowest (0.38) among persons with depression and highest among persons with hypertension (0.71). The QoL weight decreased from 0.95 for persons with very good global self-rated health to 0.20 for persons with very poor global self-rated health. The results support the feasibility and validity of the mapping approach. HRQoL varies greatly between socio-economic groups and different disease groups.
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| 6. |
- Dong, Hengjin, et al.
(författare)
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Association between health insurance and antibiotics prescribing in four counties in rural China
- 1999
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 48:1, s. 29-45
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Tidskriftsartikel (refereegranskat)abstract
- A cross-sectional study was carried out at county, township and village health care facilities in four counties in rural China in order to describe and compare the effects of health financing systems on antibiotic prescribing in outpatient care. A total of 1232 outpatients at the health care facilities was selected by multi-stage random sampling and were interviewed over 2 weeks. The results showed that health financing systems appeared to influence antibiotic prescribing in outpatient care, both in terms of frequency and of the types prescribed. The insured group had lower prescribing of antibiotics at township and village health care facilities, and for respiratory tract infections, but had higher prescribing of newer antibiotics at county and village health care facilities, for respiratory tract and g-i infections. Because there was a high patient compliance rate (94.3%) in this study the prescribing of antibiotics (supply side behavior) reflected the use of antibiotics (demand side behavior) to a great extent. Thus the results imply that antibiotics prescribing and using might be biased by the patient's health financing systems and antibiotic prescribing was the result of the interaction between physicians and patients.
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| 7. |
- Hanning, Marianne, et al.
(författare)
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Maximum waiting time - a threat to clinical freedom? : Implementation of a policy to reduce waiting times
- 2000
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 52:1, s. 15-32
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Tidskriftsartikel (refereegranskat)abstract
- This article focuses on physicians as implementers of health policy reforms. In 1992, a maximum waiting-time guarantee was introduced in Sweden. Initially the policy was a successful way to come to terms with long waiting times. However, after 2 years the waiting lists started to increase. To understand this development it is important to look at the reactions to the policy among the implementers, i.e. the physicians. Three questions are addressed: Did the implementers understand the intentions and the goals of the reform? Were they able to fulfil the guarantee? And, did they approve of the initiative? The study subjects were chief physicians at the hospital departments involved with the guarantee. Their attitudes towards the policy were ascertained by two surveys. Other material, such as statistics on waiting times, was also used. The study shows that the physicians approved of the guarantee initially. The measures taken in the first years were effective and did not conflict with earlier practice. However, increased demand in combination with economic restraints necessitated new priorities among patient groups. These changes of clinical practice did not coincide with the physicians’ professional values and hence they became more critical to the initiative and finally chose to abandon the intentions in the guarantee.
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| 8. |
- Hanning, Marianne
(författare)
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Maximum Waiting-time Guarantee - an attempt to reduce waiting lists in Sweden
- 1996
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 36:1, s. 17-35
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, as in most countries with publicly financed health services, long waiting lists for some surgical procedures have been a serious quality problem on the health policy agenda. To reduce waiting lists, the Swedish Government and the Federation of County Councils, agreed on an initiative to offer a maximum waiting-time guarantee for 12 procedures during 1992. Patients awaiting procedures are guaranteed a waiting time no longer than 3 months from the physician's decision to treat/operate. The initial agreement was to be in force for 1 year, and a grant of 500 million SEK (USD 70 million) was appropriated for the initiative. The guarantee has been prolonged by annual decisions to be in force 1993 through 1995. However, no extra resources were set aside for these years. This article describes the background and the introduction of the guarantee, and discusses some of the major results during the first 2 years. Generally, waiting lists decreased substantially during 1991 and 1992. By the end of 1992 only a few departments were unable to serve patients within 3 months. During 1993 the reduction in the waiting lists ceased, and waiting lists for some procedures showed a tendency to increase by the end of the year. The overall successful result, in terms of waiting lists and waiting times, seems to have been achieved mainly by increased production, improved administration of the waiting lists, and a change in attitudes toward waiting lists. The expectation that the guarantee would lead to a more even use of resources across the country has not been realised since it appears that hospital departments chose to expand their own activities rather than use the new opportunity offered by the guarantee to refer patients to other hospitals.
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| 9. |
- Harrison, M.I., et al.
(författare)
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The reorientation of market-oriented reforms in Swedish health-care
- 2000
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 50:3, s. 219-240
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Forskningsöversikt (refereegranskat)abstract
- Sweden was an important pioneer of market-oriented reform in publicly funded health-care systems. Yet by the mid-1990s the county councils, which fund and manage most health-care, had substantially scaled back reforms based on provider competition while continuing to constrain health budgets. As policy makers faced new issues, they turned increasingly to longer-term and more cooperative contracts to define relations between hospitals and the county councils. Growing regionalization of government and hospital mergers further reconfigured acute care and limited opportunities for competition between hospitals. We seek to explain this reorientation of market-oriented reforms between 1989 and 1996 in terms of shifts in the positions taken by powerful policy actors, and in particular by county council politicians. During this period, elections moved liberal and conservative politicians, who were the most enthusiastic supporters of market-oriented reform, in and out of control of most county governments. Meanwhile many Social Democratic politicians gradually turned from initial support of competitive reform toward opposition. Politicians and county administrators from all parties were particularly concerned about controlling health expenditures during a period of recession. In addition, the public, politicians in the counties and municipalities, and health professionals resisted steps that threatened health sector employment and would have allowed market mechanisms, rather than governments, to determine the prices and distribution of health services. During the years under study Sweden's market-oriented reforms followed a course of development similar to that taken by other management and policy fashions (Abrahamson E. Management fashion, Academy of Management Review 1996,21: 254-85). At first the reforms enjoyed uncritical support by a broad spectrum of stakeholders. Gradually participants in the reform process recognized inherent tensions among the goals of the reform, conflicts between reform programs and fundamental social and political values, unrealistic assumptions about the effects of competition, technical and organizational obstacles to implementation, and threats to interest groups. Since 1998, there have been indications that Sweden may be entering yet another stage of experimentation with market-oriented reform. Copyright (C) 2000 Elsevier Science Ireland Ltd.
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| 10. |
- Hartini, TNS, et al.
(författare)
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Energy intake during economic crisis depends on initial wealth and access to rice fields : the case of pregnant Indonesian women
- 2002
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 61:1, s. 57-71
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Tidskriftsartikel (refereegranskat)abstract
- Starting in August 1997, Indonesia experienced a radical and rapid deterioration in its economy. Between 1996 and 1998, dietary intake during the second trimester was measured in 450 pregnant women in Purworejo, Central Java, Indonesia. Using six 24 h recalls we describe the consequences of the economic crisis on the energy intake of pregnant Indonesian women. Depending on the date of data collection, women were grouped into 'before crisis', 'transition' and 'during crisis'. Mean energy intake among groups was compared using ANOVA and Student's t-test. All groups of pregnant women already had a mean energy intake before the emerging crisis that was lower than the Indonesian recommended dietary allowances (RDA). Nevertheless, energy intake differed significantly among women with different education levels (P = 0.00) and from different socio-economic groups (P = 0.00). 'During transition', a significant decrease in energy intake was experienced by urban poor women (P = 0.01). Poor women with access to rice fields had a higher rice consumption than other groups throughout the period. Our results most likely reflect the effect of higher rice price on income and welfare. 'During crisis', energy intake improved among vulnerable groups, perhaps reflecting government intervention.
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| 11. |
- Henriksen, Eva, et al.
(författare)
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Can we bridge the gap between goals and practice through a common vision? : a study of politicians and managers’ understanding of the provisions of elderly care services
- 2003
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 65:2, s. 129-137
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to identify and describe how local politicians and managers experience and understand problems and goals regarding the structures and processes involved in the care of the elderly. Qualitative methodology of a conceptual modelling workshop was used. Participants were healthcare politicians, local municipal politicians, and executive care managers. The main result was that all participants agreed on four key visions for the healthcare of the elderly: see the person, see the individual's resources, see the encounter, and see yourself. Other findings indicated that (a) care of older persons was governed by diverse interests, (b) the organisation lacked clear leadership and comprehensive goals, (c) the organisation was fragmented, and (d) there was a lack of skilled staff members to meet patient needs. Older persons were regarded as passive receivers of care or as objects that did not take an active part in health care decisions that affect them.
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| 12. |
- Holmberg, Håkan, et al.
(författare)
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Economic evaluation of screening for prostate cancer : a randomized populaionbased programme during a 10 year period in Sweden
- 1998
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 45:2, s. 133-147
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Tidskriftsartikel (refereegranskat)abstract
- Prostate cancer is a growing health problem representing considerable costs. Screening and early curative treatment may reduce morbidity and possibly prevent future escalating costs. However, population screening programmes are generally not well accepted at present due to uncerainty about whether screening for prostate cancer can result in reduced mortality. Evidence from large, randomized, controlled trials is still lacking. The objective of this study was to calculate clinical and economic consequences of general prostate cancer screening based on a limited screening trial in a Swedish community and a decision-tree model. A random selection of 1492 men (50–69 years) were invited to repeated screening in 1987. They have been examined every third year (four rounds). The other 7679 men in the population act as controls. The results show that the total incremental health care costs for prostate cacer will increase by 179 million SEK per year with screening compared to no-screening. The number of detected cases of localized cancer will increase by about 1000, which represents an additional cost of about 158 000 SEK per case. In conclusion, general screening for prostate cancer can be performed with a reasonable cost per detected localized cancer. Information on the long-term effect on life quality and cancer mortality is unknown.
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| 13. |
- Johannesson, Magnus, et al.
(författare)
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A note on prevention versus cure
- 1997
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 41:3, s. 181-187
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to test if the general Swedish population prefers saving lives through prevention or acute care. A trade-off question of a choice between saving lives through prevention or acute care was administered in a Swedish population sample. Based on the answers we estimate the median number of lives saved in acute care that is judged equivalent to saving one life through prevention. According to the results 1.2 – 1.4 lives saved in acute care is judged equivalent to saving one life through prevention. Thus our results indicate that lives saved through prevention and cure are given about the same value by the median respondent. Individuals seem to focus on the size of the health benefits rather than whether the health benefits are achieved through prevention or cure.
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| 14. |
- Johannesson, Magnus
(författare)
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A note on the depreciation of the societal perspective in economic evaluation of health care
- 1995
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 33:1, s. 59-66
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Tidskriftsartikel (refereegranskat)abstract
- It is common in cost-effectiveness analyses of health care to only include health care costs, with the argument that some fictive ‘health care budget’ should be used to maximize the health effects. This paper provides a criticism of the ‘health care budget’ approach to cost-effectiveness analysis of health care. It is argued that the approach is ad hoc and lacks theoretical foundation. The approach is also inconsistent with using a fixed budget as the decision rule for cost-effectiveness analysis. That is the case unless only costs that fall into a single annual actual budget are included in the analysis, which would mean that any costs paid by the patients should be excluded as well as any future cost changes and all costs that fall on other budgets. Furthermore the prices facing the budget holder should be used, rather than opportunity costs. It is concluded that the ‘health care budget’ perspective should be abandoned and the societal perspective reinstated in economic evaluation of health care.
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| 15. |
- Johannesson, Magnus, et al.
(författare)
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Cost-utility analysis from a societal perspective
- 1997
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Ingår i: Health Policy. - : Elsevier. - 1872-6054 .- 0168-8510. ; 39:3, s. 241-253
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we outline how to use cost-utility analysis from a societal perspective and the arguments that could be made for using such a model for economic evaluation of health care. We show that to include all the costs in the analysis, a price per quality-adjusted life years (QALY) gained rather than a given budget should be used as the decision rule. Using cost-utility analysis this way is based on a willingness to pay per QALY gained that is constant and the same for everyone. To use a fixed price per QALY gained is consistent with societal utility maximization if aggregated QALYs are a measure of societal utility and if the mix of financing sources is the same for all health care programmes. If, furthermore, the price per QALY gained is set at the optimal level, cost-utility analysis will lead to a maximization of societal utility. To get more information on the willingness to pay per QALY gained so as to provide cost-utility analysis with a useful decision rule should be a research priority.
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| 16. |
- Johannesson, Magnus
(författare)
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Economic evaluation of health care and policymaking
- 1995
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Ingår i: Health policy (Amsterdam). - : Elsevier. - 1872-6054 .- 0168-8510. ; 33:3, s. 179-190
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Tidskriftsartikel (refereegranskat)abstract
- The interest in economic evaluation of health care programmes is steadily increasing, but the impact of economic evaluations on decisions concerning the allocation of resources to health care programmes is unclear. In this paper we examine different decision and policy situations where economic evaluation of health care programmes could potentially be used. Economic evaluation as an aid to: the development of treatment guidelines, decisions within health care organizations, introduction of new medical technologies, reimbursement decisions, and pricing decisions are examined. It is concluded that economic evaluation seems to be most useful in the development of treatment guidelines and as an aid to reimbursement decisions. The importance of the incentives to use economic evaluation embodied in the health care system is also stressed. It is argued that it is too early to introduce regulations that require the use of economic evaluation in for instance reimbursement decisions. A more cautious approach may be preferred with economic evaluation used more selectively until the methods and the field have developed further.
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| 17. |
- Johannesson, Magnus
(författare)
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Economic evaluation of lipid lowering — A feasibility test of the contingent valuation approach
- 1992
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 20:3, s. 309-320
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Tidskriftsartikel (refereegranskat)abstract
- A large number of cost-effectiveness analyses of treatment of high cholesterol levels have been published the last few years. Due to the Inherent problems of cost-effectiveness analysis of prevention and the specific problems in the case of lipid lowering, it is Important to test alternative approaches. This study reports the results of a pilot study of three benefit measures based on individual preferences. Willingness to pay (WTP), willingness to give up leisure time (WTGT) and maximum acceptable risk (MAR) for lowering cholesterol levels to normal were investigated among persons with hypercholesterolaemia in a postal survey. The respondents were on average prepared to pay about SEK 450 per month, to give up about 7 hours of leisure time per week or to take an immediate mortality risk of about 1.4% to get normal lipid levels. The WTP and WTGT questions seemed to be about equally acceptable, whereas the MAR question performed less well with respect to acceptability. It is concluded that especially WTP deserves further attention, due to Its inherent advantages, since it performed at least as well as the other measures.
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| 18. |
- Johannesson, Magnus, et al.
(författare)
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Economic evaluation of osteoporosis prevention
- 1993
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Ingår i: Health policy. - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 24:2, s. 103-124
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Tidskriftsartikel (refereegranskat)abstract
- In this paper economic evaluation of osteoporosis prevention is discussed. So far economic evaluation in this area has been limited to cost-effectiveness analysis. Four cost-effectiveness analyses of osteoporosis prevention are reviewed. It is noted that the major problem with these studies is the lack of reliable and valid data to base the cost-effectiveness analyses on, which precludes clear-cut conclusions about the cost-effectiveness of osteoporosis prevention. The studies, however, form a basis for future cost-effectiveness analyses in this field and as new data become available it should be possible to improve the accuracy and precision of the analyses. Due to the methodological problems of cost-effectiveness analysis and the decisionmaker approach to economic evaluation, it is also argued that the contingent valuation (CV) method of measuring willingness to pay should be tested in this area. The CV method can be used both to value an actual treatment and the outcome of that treatment and the resulting amount can be compared with the costs (including the costs of externalities) to carry out cost-benefit analysis. It is concluded that a lot of work remains to be done in this area before economic evaluations can give a real contribution to policy, but such work may well be worthwhile due to the importance of this public health problem.
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| 19. |
- Johannesson, Magnus
(författare)
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On the estimation of cost-effectiveness ratios
- 1995
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 31:3, s. 225-229
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Tidskriftsartikel (refereegranskat)abstract
- In a recent paper Birch and Gafni criticised the use of cost-effectiveness ratios in decisions about the allocation of health care resources. To support their claim that the use of cost-effectiveness ratios will not lead to the maximization of health effects for a given budget they used an example. In this paper it is pointed out that the example used contains two basic errors. The first error is the failure to exclude dominated programmes in the estimation of incremental cost-effectiveness ratios. The second error is the failure to distinguish between independent and mutually exclusive programmes. It is concluded that to get a more sober discussion about the use and interpretation of cost-effectiveness analysis it is important that the technique is used correctly.
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| 20. |
- Johannesson, Magnus
(författare)
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The cost-effectiveness of the switch towards more expensive antihypertensive drugs
- 1994
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 28:1, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- A switch from treatment with diuretics and beta-blockers to treatment with the more expensive ACE-inhibitors and calcium-antagonists has been noted in the hypertension field. The aim of this paper was to analyse the cost-effectiveness of this switch towards more expensive antihypertensive drugs in Sweden. The upper limit of the cost-effectiveness of ACE-inhibitors and calcium-antagonists compared with diuretics and beta-blockers was estimated by assuming that ACE-inhibitors and calcium-antagonists achieve the epidemiologically expected risk reduction for coronary heart disease. The incremental cost per life-year gained varies between ∼ SEK 50 000 and ∼ SEK 6 000 000 ($1 = SEK 6) in the different patient groups analysed. It is concluded that ACE-inhibitors and calcium-antagonists may be potentially cost-effective in some patient groups at a high risk of coronary heart disease. Since an improved risk reduction has not been demonstrated in clinical trials, however, ACE-inhibitors and calcium-antagonists cannot at present be recommended for hypertension treatment in any patient groups unless treatment with diuretics and beta-blockers is contraindicated.
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| 21. |
- Johannesson, Magnus, et al.
(författare)
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The economics of ageing: on the attitude of Swedish people to the distribution of health care resources between the young and the old
- 1996
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 37:3, s. 153-161
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish Priorities Investigation [1] proposes that no account should be taken of a patient's age when allocating health care resources. Measures to save an old person's life are to be given the same priority as measures to save a young person's life. In the present study it is shown that the attitude of the Swedish population to this age-related problem is dramatically different from that laid down in the priorities investigation. On average, people are willing to sacrifice thirty-five 70-year-olds to save one 30-year-old. It is also shown that a measure which increases life-expectancy by 1 year, conditional on having survived until the age of 75 years, is given a low weighting. The (maximum) insurance premium the average Swede is willing to pay for such a programme is about £700.
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| 22. |
- Johannesson, Magnus
(författare)
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The willingness to pay for health changes, the human-capital approach and the external costs
- 1996
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 36:3, s. 231-244
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, the relationship between willingness to pay for health changes, the human-capital approach, and the costs that should be included in a cost-benefit analysis of a health care programme are analysed. The costs that should be included are defined as the change in consumption minus the change in production of the individual that receives a health care programme. The size of these external costs differs depending on the institutional arrangements in society. It is shown that the net production version of the human-capital approach is an estimation of the external costs. The human-capital approach can thus be given a theoretical foundation in cost-benefit analysis if it is used to estimate the external costs.
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| 23. |
- Lee, Stephanie, et al.
(författare)
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Patients' willingness to pay for autologous blood donation
- 1997
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 40:1, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Most cost-effectiveness analyses of autologous blood donation show very small health benefits for a substantial increase in resource utilization. However, these analyses do not consider the psychological benefits of peace of mind to patients participating in the program. In order to quantitate these benefits, we employed contingent valuation methodology to measure the willingness of patients undergoing elective surgery, to pay for autologous blood donation. The internal consistency of patient responses was investigated through correlations of willingness-to-pay values with risk perceptions and patient characteristics. Two hundred and thirty-five patients completed the self-administered questionnaire which included demographic, willingness-to-pay and risk perception questions. Median population willingness to pay for autologous blood donation was approximately $900 per patient. In multivariate analysis, willingness to pay varied significantly with dread of allogenic transfusion, perceived risk of requiring a blood transfusion and income. Patients who participate in autologous blood donation programs value the procedure highly and state they are willing to pay significant amounts out of pocket to assure themselves of available autologous blood. Willingness to pay correlated significantly with factors expected to influence value decisions.
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| 24. |
- Lundberg, Lena, et al.
(författare)
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Effects of user charges on the use of prescription medicines in different socio-economic groups
- 1998
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 44:2, s. 123-134
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Tidskriftsartikel (refereegranskat)abstract
- This study examined the sensitivity towards increases in user charges for different types of drugs and among different socio-economic groups. It was based on responses by 2008 consumers of prescription drugs to a self-administered postal questionnaire sent to a random sample of 8000 inhabitants in Uppsala County in Sweden. The questionnaire included a question about whether the respondents would use fewer prescription drugs if the user charges increased by a specific amount. The increase in user charges was varied between 9 and 150% in five different subsamples. Logistic regression analysis was used to estimate the probability that a respondent would reduce consumption of prescription drugs as a function of the size of the user charges increase, socio-economic characteristics and the type of drug used. Results showed that the price sensitivity decreased with increasing age, income, education and self-rated health status. Price sensitivity was highest for antitussives and lowest for climacteric drugs. If the user charges doubled, 40% of antitussives users would reduce their consumption whereas only 11% of climacteric drugs users would reduce their consumption. It is concluded that sensitivity to increases in user charges varied greatly between different types of drugs and between socio-economic groups. The young, those with poor health status, low education and low income are most likely to decrease consumption of prescription drugs when user charges increase.
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| 25. |
- Phongsavan, Philayrath, et al.
(författare)
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The cost-effectiveness of a cardiovascular risk reduction program in general practice
- 1997
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 41:2, s. 105-119
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Tidskriftsartikel (refereegranskat)abstract
- An economic evaluation was conducted alongside a randomised controlled trial of two lifestyle interventions and a routine care (control) group to assess the cost-effectiveness of a general practice-based lifestyle change program for patients with risk factors for cardiovascular disease. Routine care was the base case comparator because it represents ‘current therapy’ for cardiovascular disease (CVD). A ‘no care’ control group was not considered a clinically acceptable alternative to lifestyle interventions. The interventions consisted of an education guide and video for GPs to assess individual patient risk factors and plan a program for risk factor behaviour change. Each patient received a risk factor assessment, education materials, a series of videos to watch on lifestyle behaviours and some patients received a self-help booklet. Eighty-two general practitioners were randomised from 75 general practices in Sydney's Western Metropolitan Region to (i) routine care ( n = 25), (ii) video group ( n = 29) or (iii) video + self help group ( n = 28). GPs enrolled patients into the trial who met selection criteria for being at risk of CVD. There were 255 patients in the routine care (control) group, 270 in the video (intervention) group and 232 in the video + self help (intervention) group enrolled in the trial. Outcome measures included patient risk factor status: blood pressure, body mass index, cholesterol and smoking status at entry to trial and after 1 year. Changes in risk factors were used to estimate quality adjusted life years (QALYs) gained. One hundred and thirty patients in the routine care group, 199 in the video group and 155 in the video + self help group remained in the trial at the 12-month review and had complete data. The cost per QALY for males ranged from $AUD152000 to 204000. Further analysis suggests that a program targeted at ‘high risk’ males would cost approximately $30000 per QALY. The lifestyle interventions had no significant effect on cardiovascular risk factors when compared to routine patient care. There remains insufficient evidence that lifestyle programs conducted in general practices are effective. Resources for general practice-based lifestyle programs may be better spent on high risk patients who are contemplating changes in risk factor behaviours.
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| 26. |
- Serdén, Lisbeth, et al.
(författare)
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Have DRG-based prospective payment systems influenced the number of secondary diagnoses in health care administrative data?
- 2003
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 65:2, s. 101-7
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Tidskriftsartikel (refereegranskat)abstract
- Diagnosis-related groups (DRGs) are secondary patient classification systems based on primary classified medical data, in which single events of care are grouped into larger, economically and medically consistent groups. The main primary classified medical data are diagnoses and surgery codes. In Sweden, the number of secondary diagnoses per case increased during the 1990s. In the early 1990s some county councils introduced DRG systems. The present study investigated whether the introduction of such systems had influenced the number of secondary diagnoses. The nation-wide Hospital Discharge Register from 1988 to 2000 was used for the analyses. All regional hospitals were included, giving a database of 5,355,000 discharges. The hospitals were divided into those that had introduced prospective payment systems during the study period and those that had not. Among all regional hospitals, there was an increase in the number of coded secondary diagnoses, but also in the number of secondary diagnoses per case. Hospitals with prospective payment systems had a larger increase, starting after the system was introduced. Regional hospitals without prospect payment systems had a more constant increase, starting later and coinciding with the introduction of their DRG-based management systems. It is concluded that introduction of DRG-based systems, irrespective of use, focuses on recording diagnoses and therefore increases the number of diagnoses. Other reasons may also have contributed to the increase. It was found that the changes in the speciality mix, during the study period, have impact on the increase of secondary diagnoses.
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| 27. |
- Wimo, Anders, et al.
(författare)
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Time spent on informal and formal care giving for persons with dementia in Sweden
- 2002
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Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 61:3, s. 255-268
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper was to explore the time spent on caring by families of persons with dementia in Sweden. As part of a European Commission project, interviews were carried out on a sample of 92 carers, caring for persons with dementia. The interviews focused on time spent on caring, IADL, ADL and surveillance, as well as formal support received and used. Informal care, measured as hours spent caring, was about 8.5 times greater than formal services (299 and 35 h per month, respectively). Approximately 50% of the total informal care consisted of time spent on surveillance (day and night). Formal care input and informal support, in terms of ADL increased with dementia severity. A regression analysis showed that dementia severity, behavioural disturbances and coping were associated with the amount of informal care. This study gives some new perspectives on informal care giving for persons with dementia and support strategies in general. Some carers do carry a very heavy 24 h responsibility. This aspect of caring must be addressed by the development of well-targeted respite and relief support programmes.
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| 28. |
- Zethraeus, Niklas, et al.
(författare)
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Value for money? A contingent valuation study of the optimal size of the Swedish health care budget
- 1995
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 34:2, s. 135-143
-
Tidskriftsartikel (refereegranskat)abstract
- The contingent valuation method has been developed in the environmental field to measure the willingness to pay for environmental changes using survey methods. In this exploratory study the contingent valuation method was used to analyse how much individuals are willing to spend in total in the form of taxes for health care in Sweden, i.e. to analyse the optimal size of the ‘health care budget’ in Sweden. A binary contingent valuation question was included in a telephone survey of a random sample of 1260 households in Sweden. With a conservative interpretation of the data the result shows that 50% of the respondents would accept an increased tax payment to health care of about SEK 60 per month ($1 = SEK 8). It is concluded that the results indicate that the population overall thinks that the current spending on health care in Sweden is on a reasonable level. There seems to be a willingness to increase the tax payments somewhat, but major increases does not seem acceptable to a majority of the population.
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| 29. |
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| 30. |
- Bardage, Cecilia, et al.
(författare)
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Non-prescription medicines for pain and fever : A comparison of recommendations and counseling from staff in pharmacy and general sales stores
- 2013
-
Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 110:1, s. 76-83
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study is to map and analyze the content and quality of theencounter when customers buy non-prescription medicines for pain and fever.Methods: 297 pharmacies and 801 general sales stores (GSS) in Sweden were selected. A"Mystery shopper" exercise was conducted. Three scenarios were used and a total of 366units were selected for each scenario. There were in total 625 observers: 208 in the childwith fever scenario, 225 in the Reliv scenario, and 192 in the painkiller during pregnancyscenario. Data collection: 21st September to 20th November 2011.Results: In two out of three visits to GSS, the staff proposed a medicine for a heavily pregnantwoman. The staff suggested in 9% of the visits a medicine that is inappropriate in latepregnancy. The corresponding percentage in pharmacies was 1%.Both pharmacies and GSS proposed, in 6% a medicine that is inappropriate for babies toa feverish child. Only 16% of the pharmacists and 14% of the staff in GSS asked for the ageof the child.General sales staff recommended in 10% ibuprofen and in 4% an acetylsalicylic acid productwhen an acetaminophen preparation was requested. The corresponding percentage inthe pharmacy were 4% ibuprofen, 2% diclofenac, and 1% an acetylsalicylic acid product.Conclusions: The staff in GSS and pharmacies do not pay sufficient attention to the heterogeneityof painkillers, which lead to inappropriate recommendations.
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| 31. |
- Bergerum, Carolina, 1967-, et al.
(författare)
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Organising and managing patient and public involvement to enhance quality improvement—Comparing a Swedish and a Dutch hospital
- 2022
-
Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 126:7, s. 603-612
-
Tidskriftsartikel (refereegranskat)abstract
- As co-production approaches to quality improvement (QI) gain importance in healthcare, hospital leaders and managers are expected to organise and support such efforts. Yet, patient and public involvement (PPI) can be challenging. Hospital organisations, emphasising knowledge and evidence domains, are characterised by operational-professional rather than patient-preference led management. Thus, PPI adds aspects of influence and responsibility that are not clearly defined or understood, with limited knowledge about how it can be orchestrated. This study, therefore, aimed to explore hospital leaders’ and managers’ contextualised experiences of managing QI efforts involving patients, by comparing two European hospitals.The study draws on field observations and qualitative interviews with a total of 21 QI team leaders and hospital managers in a Swedish and a Dutch hospital organisation. The data were subjected to thematic analysis with a critical realist approach.Results define seven themes, or areas, in which mechanisms are at play: (1) patient involvement in hospital QI, and (2) improving outcomes for patients, originating from the strategic view of achieving the hospital vision. Furthermore, (3) societal influence, (4) knowledge and evidence, (5) complexity, (6) individual resources, and (7) cooperation are areas in which mechanisms operate in the process. These areas are equally relevant for both hospitals, yet the mechanisms involved play out differently depending on contextual structure and local means of action.
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| 32. |
- Bernsten, Cecilia, et al.
(författare)
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A comparative analysis of remuneration models for pharmaceutical professional services
- 2010
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 95:1, s. 1-9
-
Forskningsöversikt (refereegranskat)abstract
- Objectives: Pharmacists provide a wide range of professional services to support the appropriate use of medicines by patients. This study aims to conduct an international, comparative analysis of remuneration models for pharmaceutical professional services. Methods: Information about remuneration models was derived from a literature review and a semi-structured questionnaire completed by experts. Results: Remuneration models differ in the way that pharmacists are paid for professional services beyond dispensing medicines. Also, the scope of services that are remunerated varies. The majority of countries regulate remuneration for services only when the medicine is paid for under the reimbursement scheme. Remuneration of services implies a commitment to assure their quality in some countries. Collaborative practice models have been set up where pharmacists work together with other health care professionals to deliver diagnosis-specific services or services based on the patient's use of medicines. The remuneration of services is influenced by the value of services. budgetary constraints, the payer perspective, and the attitude of physicians, pharmacists and patients. Conclusions: Professional organisations need to formulate a clear strategy for developing and gaining remuneration for pharmaceutical professional services. This implies that pharmacists not only demonstrate the value of services, but also assure their quality. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
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| 33. |
- Björkman, Ingeborg, et al.
(författare)
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The Swedish A(H1N1) vaccination campaign : Why did not all Swedes take the vaccination?
- 2013
-
Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 109:1, s. 63-70
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn Sweden, a mass vaccination campaign against the influenza A(H1N1) 2009 resulted in 60% vaccination coverage. However, many countries had difficulty in motivating citizens to be vaccinated. To be prepared for future vaccination campaigns, it is important to understand people's reasons for not taking the vaccination.ObjectiveThe aim of this qualitative study was to explore motives, beliefs and reactions of individuals with varying backgrounds who did not get vaccinated.Data and methodsThe total 28 individuals participating in the interviews were permitted to speak freely about their experiences and ideas about the vaccination. Interviews were analysed using a Grounded Theory approach. The strength of participants' decisions not to be vaccinated was also estimated.FindingsPatterns of motives were identified and described in five main categories: (A) distinguishing between unnecessary and necessary vaccination, (B) distrust, (C) the idea of the natural, (D) resisting an exaggerated safety culture, and (E) injection fear. The core category, upholding autonomy and own health, constitutes the base on which the decisions were grounded.ConclusionA prerequisite for taking the vaccine would be that people feel involved in the vaccination enterprise to make a sensible decision regarding whether their health will be best protected by vaccination.
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| 34. |
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| 35. |
- Bremer, Patrick, et al.
(författare)
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Informal dementia care: Consequences for caregivers' health and health care use in 8 European countries.
- 2015
-
Ingår i: Health Policy. - : Elsevier BV. - 1872-6054 .- 0168-8510. ; 119:11, s. 1459-1471
-
Tidskriftsartikel (refereegranskat)abstract
- Informal (dementia) care has economic consequences throughout the health care system. Whilst the health and wellbeing of the care recipient might improve, the health of the caregiver might also change, typically for the worse. Therefore, this analysis aims to examine the association between caregiving intensity and caregivers' health and health care utilization.
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| 36. |
- Broqvist, Mari, 1958-, et al.
(författare)
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The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
- 2018
-
Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 122:6, s. 630-637
-
Tidskriftsartikel (refereegranskat)abstract
- The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.
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| 37. |
- Burström, Kristina, et al.
(författare)
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A comparison of individual and social time trade-off values for health states in the general population
- 2006
-
Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 76:3, s. 359-370
-
Tidskriftsartikel (refereegranskat)abstract
- This study aimed to compare directly elicited individual time trade-off (TTO) values in a general population sample with the social values derived using the UK EQ-5D index tariff. In the Stockholm County 1998 postal Public Health Survey (n =4950, 20–88 years), the EQ-5D self-classifier, a TTO and a rating scale (RS) question were included (n = 2549 for all three questions). The mean TTO (EQ-5D) value was 0.943 (0.890) in the youngest age-group and 0.699 (0.733) in the oldest age-group. The difference between TTO and EQ-5D values was greater in more severe health status groups was. The same equation as for the UK EQ-5D index tariff was estimated for TTO and RS and resulted in significant and consistent coefficients for nearly all dimensions. The coefficients for moderate problems were closer to the EQ-5D index tariff than the coefficients for severe problems. Age was also significant after controlling for the EQ-5D dimensions (p < 0.05). The results suggest that individual and social TTO values differ systematically and that the difference is greater the more severe the health status is. The social EQ-5D index tariff may also underestimate the severity in health status at older ages; age appears to correlate with additional health problems not captured by the EQ-5D classification.
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| 38. |
- Calltorp, J
(författare)
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Priority-setting in health policy in Sweden and a comparison with Norway
- 1999
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 50:1-2
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Tidskriftsartikel (refereegranskat)abstract
- The development of priority setting policies has been an important part of the national agenda for health services in Sweden and Norway during the past 10 years. Both countries have health systems with a pronounced public character and a declared emphasis on equity and solidarity. Both countries have also bad National Priority Commissions that have developed general documents providing advice, but not very detailed guidelines, on how to set priorities, Resource constraints and the rapid restructuring of the health care system were important characteristics forming the background for the National Priority Commission in Sweden (1995). In Norway, the starting point for the first-ever Priority Commission in the world (1987) was how to set limits for health care in a society with rapidly increasing wealth. The second Norwegian Commission (1997) critically reviewed the effects of the general principles for priority setting that have been put forward, and demonstrated the importance to link them to steering tools within health care services. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.
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| 39. |
- Carson, Dean B., et al.
(författare)
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The 'rural pipeline' and retention of rural health professionals in Europe's northern peripheries
- 2015
-
Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 119:12, s. 1550-1556
-
Tidskriftsartikel (refereegranskat)abstract
- The major advance in informing rural workforce policy internationally over the past 25 years has been the recognition of the importance of the 'rural pipeline'. The rural pipeline suggests that people with 'rural origin' (who spent some childhood years in rural areas) and/or 'rural exposure' (who do part of their professional training in rural areas) are more likely to select rural work locations. What is not known is whether the rural pipeline also increases the length of time professionals spend in rural practice throughout their careers. This paper analyses data from a survey of rural health professionals in six countries in the northern periphery of Europe in 2013 to examine the relationship between rural origin and rural exposure and the intention to remain in the current rural job or to preference rural jobs in future. Results are compared between countries, between different types of rural areas (based on accessibility to urban centres), different occupations and workers at different stages of their careers. The research concludes that overall the pipeline does impact on retention, and that both rural origin and rural exposure make a contribution. However, the relationship is not strong in all contexts, and health workforce policy should recognise that retention may in some cases be improved by recruiting beyond the pipeline.
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| 40. |
- Dahlgren, Cecilia, et al.
(författare)
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Simply the best? The impact of quality on choice of primary healthcare provider in Sweden
- 2021
-
Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 125:11, s. 1448-1454
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: One of the more important objectives with the patient choice reform, introducing non-price competition in Swedish primary healthcare, was to improve performance and quality of care. However, in order for choice to lead to quality improvements, citizens need to consider quality aspects in their choices of provider. We hypothesize that quality of care influences choice of provider and the objective of this study is to investigate if citizens are willing to make a trade-off between distance to chosen provider and quality of care. Methods: We use conditional logit models to analyse if quality and other provider attributes influence choice of provider. The study population includes all citizens of Region Stockholm with at least one primary healthcare contact (N ~1.4 million). Results: The results show that distance is the most important factor in choosing a primary healthcare provider but that there seems to be a willingness to make a trade-off between distance and quality measures. However, other provider attributes, such as the Care Need Index of the registered population, seem to influence choice to a greater extent than quality. Conclusion: The results point in the same direction as the arguments behind the patient choice reform. However, the effects are marginal. To enhance quality competition, policy makers should consider making quality information at the provider level more accessible.
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| 41. |
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| 42. |
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| 43. |
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| 44. |
- Ekman, Björn
(författare)
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Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country.
- 2007
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Ingår i: Health Policy. - : Elsevier BV. - 1872-6054 .- 0168-8510. ; 83:2-3, s. 304-313
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of the study is to quantitatively analyze the role of health insurance in the determinants of catastrophic health payments in a low-income country setting. Methods: The study uses the most recent publicly available household level data from Zambia collected in 1998 containing detailed information on health care utilization and spending and on other key individual, household, and community factors. An econometric model is estimated by means of multivariate regression. Results: The main results are counterintuitive in that health insurance is not found to provide financial protection against the risk of catastrophic payments; indeed, insurance is found to increase this risk. Conclusions: Reasons for the findings are discussed using additional available information focusing on the amount of care per illness episode and the type of care provided. The key conclusion is that the true impact of health insurance is an empirical issue depending on several key context factors, including quality assurance and service provision oversight.
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| 45. |
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| 46. |
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| 47. |
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| 48. |
- Fredriksson, Mio, 1976-, et al.
(författare)
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Awareness and opinions on healthcare decommissioning in a Swedish region
- 2020
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 124:9, s. 991-997
-
Tidskriftsartikel (refereegranskat)abstract
- Decision-makers may have to decommission services as a response to budget deficits. The aim of this study was to investigate a case of decommissioning with regard to the public's awareness and opinions. The analysis of a survey in a Swedish region that begun the implementation of an extensive decommissioning programme in 2015 shows that the majority of respondents were well or very well informed about the programme (68 %). A large proportion of the respondents thought the decision-makers to a low or very low degree had adopted appropriate measures to solve the economic problems (43 %), but together more respondents were either indifferent (39.5 %) or positive (17.5 %). Regarding the level of satisfaction with the region's healthcare system, compared to prior to the decommissioning period, 30 % were less satisfied while together more were either indifferent (48 %) or had become more satisfied (22 %). The large share of indifferent responses opens up for various interpretations or framings of the programme outcomes. Trust in the regions' healthcare system nevertheless increased during the same period. Furthermore, self-assessed health as well as age and utilization seem to be associated with healthcare system satisfaction during decommissioning. This illustrates heterogeneity in the public's responses to decommissioning, which calls for further investigation.
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| 49. |
- Fredriksson, Mio, 1976-
(författare)
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Is patient choice democratizing Swedish primary care?
- 2013
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 111:1, s. 95-98
-
Tidskriftsartikel (refereegranskat)abstract
- Choice and competition reforms in healthcare often involve the idea of empowering patients through the mechanism of ‘exit’. Using Swedish healthcare as an example, this article illustrates that this kind of efforts to empower patients may not only affect patients’ chances of influencing healthcare but also those of citizens, who may lose ‘voice’ as a result. Thus, it is an example of the conflict between representative democracy and the customers’ control over welfare services; a conflict that may be overcome by providing new forms of collective decision-making. This was not the case when introducing a patient choice reform in Swedish primary care in 2010.
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| 50. |
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