| 1. |
- Beckman, Anders, et al.
(författare)
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Country of birth, socioeconomic position, and health care expenditure― a multilevel analysis of the city of Malmö, Sweden
- 2004
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 58:2, s. 145-149
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Tidskriftsartikel (refereegranskat)abstract
- Study objective: The principle of equity aims to guarantee allocation of healthcare resources on the basis of need. Therefore, people with a low income and persons living alone are expected to have higher healthcare expenditures. Besides these individual characteristics healthcare expenditure may be influenced by country of birth. This study therefore aimed to investigate the role of country of birth in explaining individual healthcare expenditure.Design: Multilevel regression model based on individuals (first level) and their country of birth (second level).Setting: The city of Malmö, Sweden.Participants: All the 52 419 men aged 40–80 years from 130 different countries of birth, who were living in Malmö, Sweden, during 1999.Main results: At the individual level, persons with a low income and persons living alone showed a higher healthcare expenditure, with regression coefficients (and 95% confidence intervals) being 0.358 (0.325 to 0.392) and 0.197 (0.165 to 0.230), respectively. Country of birth explained a considerable part (18% and 13%) of the individual differences in the probability of having a low income and living alone, respectively. However, this figure was only 3% for having some health expenditure, and barely 0.7% with regard to costs in the 74% of the population with some health expenditure.Conclusions: Malmö is a socioeconomically segregated city, in which the country of birth seems to play only a minor part in explaining individual differences in total healthcare expenditure. These differences seem instead to be determined by individual low income and living alone.
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| 2. |
- Clarke, PM, et al.
(författare)
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A note on the decomposition of the health concentration index
- 2003
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Ingår i: Health Economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 12:6, s. 511-516
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Tidskriftsartikel (refereegranskat)abstract
- In recent work, the concentration index has been widely used as a measure of income-related health inequality. The purpose of this note is to illustrate two different methods for decomposing the overall health concentration index using data collected from a Short Form (SF-36) survey of the general Australian population conducted in 1995. For simplicity, we focus on the physical functioning scale of the SF-36. Firstly we examine decomposition 'by component' by separating the concentration index for the physical functioning scale into the ten items on which it is based. The results show that the items contribute differently to the overall inequality measure, i.e. two of the items contributed 13% and 5%, respectively, to the overall measure. Second, to illustrate the 'by subgroup' method we decompose the concentration index by employment status. This involves separating the population into two groups: individuals currently in employment; and individuals not currently employed. We find that the inequality between these groups is about five times greater than the inequality within each group. These methods provide insights into the nature of inequality that can be used to inform policy design to reduce income related health inequalities. Copyright (C) 2002 John Wiley Sons, Ltd.
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| 3. |
- Clarke, PM, et al.
(författare)
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On the measurement of relative and absolute income-related health inequality
- 2002
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Ingår i: Social Science and Medicine. - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 55:11, s. 1923-1928
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Tidskriftsartikel (refereegranskat)abstract
- In recent work on international comparisons of income-related inequalities in health, the concentration index has been used as a measure of health inequality. A drawback of this measure is that it is sensitive to whether it is estimated with respect to health or morbidity. An alternative would be to use the generalized concentration index that is based on absolute rather than relative health differences. In this methodological paper, we explore the importance of the choice of health inequality measure by comparing the income-related inequality in health status and morbidity between Sweden and Australia. This involves estimating a concentration index and a generalized concentration index for the eight-scale health profile of the Short Form 36 (SF-36) health survey. We then transform the scores for each scale into a measure of morbidity and show that whether the concentration index is estimated with respect to health or morbidity has an impact on the results. The ranking between the two countries is reversed for two of the eight dimensions of SF-36 and within both countries the ranking across the eight SF-36 scales is also affected. However, this change in ranking does not occur when the generalized concentration index is compared and we conclude with the implications of these results for reporting comparisons of income-related health inequality in different populations. (C) 2002 Elsevier Science Ltd. All rights reserved.
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| 4. |
- De Graeve, Diana, et al.
(författare)
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Equity in the delivery of health care in Europe and the US
- 2000
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Ingår i: Journal of health economics. - : Elsevier B.V. - 1879-1646 .- 0167-6296. ; 19:5, s. 553-583
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives.
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| 5. |
- Gerdtham, Ulf, et al.
(författare)
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A note on the effect of unemployment on mortality
- 2003
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Ingår i: Journal of health economics. - : Elsevier B.V. - 1879-1646 .- 0167-6296. ; 22:3, s. 505-518
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Tidskriftsartikel (refereegranskat)abstract
- In this note we test if unemployment has an effect on mortality using a large individual level data set of nearly 30,000 individuals in Sweden aged 20–64 years followed-up for 10–17 years. We follow individuals over time that are initially in the same health state, but differ with respect to whether they are employed or unemployed (controlling also for a number of individual characteristics that may affect the depreciation of health over time). Unemployment significantly increases the risk of being dead at the end of follow-up by nearly 50% (from 5.36 to 7.83%). In an analysis of cause-specific mortality, we find that unemployment significantly increases the risk of suicides and the risk of dying from “other diseases” (all diseases except cancer and cardiovascular), but has no significant effect on cancer mortality, cardiovascular mortality or deaths due to “other external causes” (motor vehicle accidents, accidents and homicides).
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| 6. |
- Gerdtham, Ulf, et al.
(författare)
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Absolute income, relative income, income inequality, and mortality
- 2004
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Ingår i: Journal of Human Resources. - : University of Wisconsin Press. - 0022-166X .- 1548-8004. ; 39:1, s. 228-247
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Tidskriftsartikel (refereegranskat)abstract
- We test whether mortality is related to individual income, mean community income, and community income inequality, controlling for initial health status and personal characteristics. The analysis is based on a random sample from the adult Swedish population of more than 40, 000 individuals who were followed up for 10-17 years. We find that mortality decreases significantly as individual income increases. For mean community income and community income inequality we cannot, however, reject the null hypothesis of no effect on mortality. This result is stable with respect to a number of measurement and specification issues explored in an extensive sensitivity analysis.
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| 7. |
- Gerdtham, Ulf, et al.
(författare)
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Do life-saving regulations save lives ?
- 2002
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Ingår i: Journal of Risk and Uncertainty. - : Springer Nature. - 1573-0476 .- 0895-5646. ; 24:3, s. 231-249
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Tidskriftsartikel (refereegranskat)abstract
- Life-saving regulations may be counter-productive since they have an indirect mortality effect through the reduction in disposable income. This paper estimates the effect of income on mortality, controlling for the initial health status and a host of personal characteristics. The analysis is based on a random sample of the adult Swedish population of over 40,000 individuals followed up for 10-17 years. The income loss that will induce an expected fatality is estimated to be $6.8 million when the costs are borne equally among all adults, $8.4 million when the costs are borne proportionally to income and $9.8 million when the costs are borne progressively to income.
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| 8. |
- Gerdtham, Ulf-G., et al.
(författare)
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Equity in Swedish health care reconsidered: new results based on the finite mixture model
- 2001
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Ingår i: Health economics. - : John Wiley & Sons, Ltd. - 1099-1050 .- 1057-9230. ; 10:6, s. 565-572
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Tidskriftsartikel (refereegranskat)abstract
- This paper reconsiders the equity issue in Swedish health care utilization previously analysed by Gerdtham (Health Econ 1997; 6: 303-319) within the framework of the standard two-part model. Departing from the user/non-user distinction, we use the more flexible framework of the finite mixture model that distinguishes between frequent/infrequent users. Our results indicate that the support for the inequity hypothesis reported by Gerdtham is sensitive to model specification and the way standard errors of coefficients are estimated. The new framework offers an alternative perspective on the magnitude of the income-related difference in health care utilization. Copyright © 2001 John Wiley & Sons, Ltd.
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| 9. |
- Gerdtham, Ulf-G, et al.
(författare)
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Health System Effects on Cost Efficiency in the OECD Countries
- 2001
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Ingår i: Applied economics. - : Informa UK Limited. - 1466-4283 .- 0003-6846. ; 33:5, s. 643-647
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Tidskriftsartikel (refereegranskat)abstract
- This paper investigates the effects of different health systems on cost efficiency in inpatient health care among the OECD countries. The results indicate that public contract systems are more efficient and that public integrated systems are less efficient than public reimbursement systems.
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| 10. |
- Gerdtham, Ulf G., et al.
(författare)
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Income-related inequality in life-years and quality-adjusted life-years
- 2000
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Ingår i: Journal of Health Economics. - 0167-6296 .- 1879-1646. ; 19:6, s. 1007-1026
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Tidskriftsartikel (refereegranskat)abstract
- We estimate the income-related inequality in Sweden with respect to life-years and quality-adjusted life-years (QALYs). We use a large data set from Sweden with over 40,000 individuals followed up for 10-16 years, to estimate the survival and quality-adjusted survival in different income groups. For both life-years and QALYs, we discover inequalities in health favouring the higher income groups. For men (women) in the youngest age-group (20-29 years), the number of QALYs is 43.7 (45.7) in the lowest income decile and 47.2 (49.0) in the highest income decile. (C) 2000 Elsevier Science B.V.
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