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| 2. |
- Merlo, Juan, et al.
(författare)
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God vård på lika villkor vid hjärtinfarkt i dagens Sverige. Geografiska skillnader i dödlighet utan betyd
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:1-2, s. 20-23
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Tidskriftsartikel (refereegranskat)abstract
- It is a known fact that the 1990s brought a decrease in mortality after myocardial infarction in Sweden but that differences in mortality rates following myocardial infarction still remain between the Swedish counties. Unresolved, however, are questions as to what these inter-county differences mean for the individual patient and what role hospital care plays in this context. We analysed all patients aged 64-85 years who were hospitalised following diagnosis of myocardial infarction in Sweden during the period 1993-1996. To gain an understanding of the relevance of geographical differences in mortality after myocardial infarction for the individual patient we applied multi-level regression analysis and calculated county and hospital median odds ratios (MORs) in relation to 28-day mortality. For hospitalised patients with myocardial infarction, being cared for in another hospital with higher mortality would increase the risk of dying by 9% (MOR=1.09) in men and 12% in women. If these patients moved to another county with higher mortality the risk would increase by 7% and 3%, respectively. The small geographical differences in 28-day mortality after myocardial infarction found in Sweden suggest a high degree of equality across the country; however, further improvement could be achieved in hospital care, especially for women - an issue that deserves further analysis.
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| 3. |
- Ohlsson, H, et al.
(författare)
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Understanding adherence to official guidelines on statin prescribing in primary health care-a multi-level methodological approach.
- 2005
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 61:Aug 25, s. 657-665
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim was to investigate the role that municipalities and out-patient health care centres (HCCs) have in understanding adherence to official guidelines on statin prescribing. Our hypothesis was that after guideline publication, adherence to recommended statin prescription would increase and variance among HCCs and municipalities would decrease. Since multi-level regression analysis (MLRA) is a relatively new methodology in pharmacoepidemiology, we also aimed to explore the application of MLRA in our investigation. Methods: We obtained data from the Swedish Corporation of Pharmacies record of sales regarding all initial prescriptions of statins issued between April and December 2003. We applied multi-level analysis on 34,514 individual prescriptions (level 1) nested within 226 HCCs (level 2), which in turn were nested within 33 municipalities (level 3). Temporal trends and gender differences were investigated by means of random slope analysis. Variance was expressed using median odds ratio (MOR) and interval odds ratio. Results: HCCs appeared to be more relevant than municipalities for understanding the physicians' propensity to prescribe a recommended statin (MORHCC=1.96 and MORMunicipality=1.41). Overall prevalence of adherence was very low (about 20%). After publication of the guidelines, prescription of recommended statins increased, and variance among HCCs decreased but only during the first 4 months of the observation period. Conclusion: The publication of official guidelines in the county of Scania exerted a positive influence on statin prescription but, at the end of the observation period, adherence was still low and practice variation high. These facts may reflect inefficient therapeutic traditions and suggest that more intensive interventions may be necessary to promote rational statin prescription.
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| 4. |
- Axelson, Henrik, et al.
(författare)
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Health financing for the poor produces promising short-term effects on utilization and out-of-pocket expenditure: evidence from Vietnam
- 2009
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Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vietnam introduced the Health Care Fund for the Poor in 2002 to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities. It is often argued that effects of financing reforms take a long time to materialize. This study evaluates the short-term impact of the program to determine if pro-poor financing programs can achieve immediate effects on health care utilization and out-of-pocket expenditure. Method: Considering that the program is a non-random policy initiative rolled out nationally, we apply propensity score matching with both single differences and double differences to data from the Vietnam Household Living Standards Surveys 2002 (pre-program data) and 2004 (first post-program data). Results: We find a small, positive impact on overall health care utilization. We find evidence of two substitution effects: from private to public providers and from primary to secondary and tertiary level care. Finally, we find a strong negative impact on out-of-pocket health expenditure. Conclusion: The results indicate that the Health Care Fund for the Poor is meeting its objectives of increasing utilization and reducing out-of-pocket expenditure for the program's target population, despite numerous administrative problems resulting in delayed and only partial implementation in most provinces. The main lessons for low and middle-income countries from Vietnam's early experiences with the Health Care Fund for the Poor are that it managed to achieve positive outcomes in a short time-period, the need to ensure adequate and sustained funding for targeted programs, including marginal administrative costs, develop effective targeting mechanisms and systems for informing beneficiaries and providers about the program, respond to the increased demand for health care generated by the program, address indirect costs of health care utilization, and establish and maintain routine and systematic monitoring and evaluation mechanisms.
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| 5. |
- Clarke, Philip M., et al.
(författare)
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Optimal recall length in survey design
- 2008
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Ingår i: Journal of Health Economics. - : Elsevier BV. - 1879-1646 .- 0167-6296. ; 27:5, s. 1275-1284
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Tidskriftsartikel (refereegranskat)abstract
- Self-reported data collected Via Surveys are a key input into a wide range of research conducted by economists. It is well known that Such data are subject to measurement error that arises when respondents are asked to recall past utilisation. Survey designers Must determine the length of the recall period and face a trade-off as increasing the recall period provides more information, but increases the likelihood of recall error. A statistical framework is used to explore this trade-off. Finally we illustrate how optimal recall periods call be estimated using hospital use data from Sweden's Survey of Living Conditions. (c) 2008 Published by Elsevier B.V.
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| 6. |
- Eek, Frida, et al.
(författare)
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Health Care Utilisation and Attitudes towards Health Care in Subjects Reporting Environmental Annoyance from Electricity and Chemicals.
- 2009
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Ingår i: Journal of Environmental and Public Health. - : Hindawi Limited. - 1687-9813 .- 1687-9805. ; 2009:Apr 14
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Tidskriftsartikel (refereegranskat)abstract
- Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT). Methods. Postal questionnaire (n = 13 604) and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group.
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| 8. |
- Gerdtham, Ulf, et al.
(författare)
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Deaths rise in good economic times: evidence from the OECD.
- 2006
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Ingår i: Economics and Human Biology. - : Elsevier BV. - 1873-6130 .- 1570-677X. ; 4:3, s. 298-316
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Tidskriftsartikel (refereegranskat)abstract
- This study uses aggregate data for 23 Organization for Economic Cooperation and Development (OECD) countries over the 1960-1997 period to examine the relationship between macroeconomic conditions and deaths. The main finding is that total mortality and deaths from several common causes rise when labor markets strengthen. For instance, controlling for year effects, location fixed-effects (FE), country-specific time trends and demographic characteristics, a 1% point decrease in the national unemployment rate is associated with growth of 0.4% in total mortality and the following increases in cause-specific mortality: 0.4% for cardiovascular disease, 1.1% for influenza/pneumonia, 1.8% for liver disease, 2.1% for motor vehicle deaths, and 0.8% for other accidents. These effects are particularly pronounced for countries with weak social insurance systems, as proxied by public social expenditure as a share of GDP. The findings are consistent with evidence provided by other recent research and cast doubt on the hypothesis that economic downturns have negative effects on physical health. (c) 2006 Elsevier B.V. All rights reserved.
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| 9. |
- Gerdtham, Ulf, et al.
(författare)
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Estimating the Cost of Diabetes Mellitus-Related Events from Inpatient Admissions in Sweden Using Administrative Hospitalization Data
- 2009
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Ingår i: PharmacoEconomics. - 1179-2027. ; 27:1, s. 81-90
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: To estimate short- and long-term costs of inpatient hospitalization in Sweden for major diabetes mellitus-related events. Materials and methods: Costs were estimated using administrative hospital data from the Swedish National Board of Health and Welfare, which is linked to the Swedish National Diabetes Register. Data were available for 179 749 patients with diabetes in Sweden from 1998 to 2003 (mean and median duration of 6 years' follow-up). Costing of inpatient admissions was based on Nordic diagnosis-related groups (NordDRG). Multiple regression analysis (linear and generalizing estimating equation models) was used to estimate inpatient care costs controlling for age, sex and co-morbidities. The data on hospitalizations were converted to costs (E) using 2003 exchange rates. Results: The average annual costs (linear model) associated with inpatient admissions for a 60-year-old male in the year the first event first occurred were as follows: (sic)6488 (95% CI 5034, 8354) for diabetic coma; (sic)6850 (95% CI 6514, 7204) for heart failure; (sic)7853 (95% CI 7559, 8144) for non-fatal stroke; (sic)8121 (95% CI 7104, 9128) for peripheral circulatory complications; (sic)8736 (95% CI 8474, 9001) for non-fatal myocardial infarction (MI); (sic) 10 360 (95% CI 10 085, 10 643) for ischaemic heart disease; (sic) 11411 (95% CI 10 298, 12 654) for renal failure; and (sic)14 949 (95% CI 13 849, 16 551) for amputation. On average, the costs were higher when co-morbidity was accounted for (e.g. MI with co-morbidity was twice as costly as MI alone). Conclusions: Average hospital inpatient costs associated with common diabetes-related events can be estimated using panel data regression methods. These could assist in modelling of long-term costs of diabetes and in evaluating the cost effectiveness of improving care.
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| 10. |
- Gerdtham, Ulf, et al.
(författare)
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Factors affecting chronic obstructive pulmonary disease (COPD)-related costs: a multivariate analysis of a Swedish COPD cohort.
- 2009
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Ingår i: The European journal of health economics : HEPAC : health economics in prevention and care. - : Springer Science and Business Media LLC. - 1618-7598 .- 1618-7601. ; 10:2, s. 217-26
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Tidskriftsartikel (refereegranskat)abstract
- Chronic obstructive pulmonary disease (COPD) is an increasing public health problem, generating considerable costs. The objective of this study was to identify factors affecting COPD-related costs. A cohort of 179 subjects with COPD was interviewed over the telephone on four occasions about their annual use of COPD-related resources. The data set and explanatory variables were analysed by means of multivariate regression techniques for six different types of cost: societal (or total), direct (health care) and indirect (productivity), and three subcomponents of direct costs-hospitalisation, outpatient and medication. Poor lung function, dyspnoea and asthma were independently associated with higher costs. Poor lung function (severity of COPD) significantly increased all six examined cost types. Dyspnoea (breathing problems) also increased costs, though to a varying extent. The presence of reported asthma increased total, direct, outpatient and medication costs. Poor lung function and, to a lesser extent, extent of dyspnoea and concomitant asthma, were all strongly associated with higher COPD-related costs. Strong efforts should be made to prevent the progression of COPD and its symptoms.
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