| 1. |
- Andersson, Karolina, 1978, et al.
(author)
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Do policy changes in the pharmaceutical reimbursement schedule affect drug expenditures? Interrupted time series analysis of cost, volume and cost per volume trends in Sweden 1986-2002.
- 2006
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In: Health policy (Amsterdam, Netherlands). - : Elsevier BV. - 0168-8510. ; 79:2-3, s. 231-43
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Journal article (peer-reviewed)abstract
- The last decades increasing pharmaceutical expenditures in Sweden and other western countries have created a need for reforms to reduce the trend. The aim was to analyse if reforms concerning the pharmaceutical reimbursement scheme in Sweden during the years 1986-2002 were associated with changes in cost, volume and cost per volume of pharmaceuticals. Effects of changes in the reimbursement schedule during the study period were evaluated for all registered pharmaceuticals in Sweden and for five indicator drug groups. Five policy changes during the study period were assessed. Three concerned increased patient co-payment (January 1, 1991; January 1, 1995 and June 1, 1999), one the introduction of reference based pricing and increased co-payment (January 1, 1993) and one a new structure of the reimbursement schedule (January 1, 1997). The National Corporation of Swedish Pharmacies provided pharmaceutical delivery data for all Swedish pharmacies. Possible breaks in the trend associated with the investigated reforms were analysed with linear segmented regression analysis. This showed that increased co-payments were not associated with changed level or slope of cost and volume. The new reimbursement schedule was associated with a decreased level of cost and volume, both for all drugs combined and for several of the indicator drug groups. It was also associated with an increased slope for both volume and cost in some indicator drug groups and for all drugs. Introduction of reference based pricing was associated with a reduced slope of cost/defined daily doses (DDD) in all of the indicator drug groups and for all drugs. The analysis showed that major changes in the reimbursement system such as the introduction of a new reimbursement schedule and reference based pricing were associated with reductions in cost and volume for the new reimbursement schedule and cost per volume for reference based pricing.
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| 4. |
- Deshpande, Kirti, et al.
(author)
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Spatial pattern of private health care provision in Ujjain, India: a provider survey processed and analysed with a Geographical Information System
- 2004
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In: HEALTH POLICY. - : Elsevier BV. - 0168-8510. ; 68:2, s. 211-222
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Journal article (peer-reviewed)abstract
- In developing countries like India, official information on private health care providers is scanty. This is an obstacle for effective health care planning and policy development. In this paper, we present a project aimed to enumerate, characterise and digitally map all private providers (PPs) using Geographical Information System (GIS) in a rural district in India. A team of surveyors carried out a census of private providers in the district. This data was combined with official data on geophysical characteristics and infrastructure, demographic situation and location of settlements and public health care providers. This study highlights the need to consider PPs in health policy making in India. The survey identified about 2000 additional PPs over and above those listed with the health authorities. About half practised modern medicine (Allopathy) while the rest practised other types of formal medical systems (Ayurveda or Homeopathy) or informal therapeutic systems. Individuals with no formal health care training constituted the majority of PPs. Formally trained doctors were highly concentrated in urban areas while trained non-doctors and untrained PPs dominated in the rural areas. The study shows how GIS can be used to create an improved basis for health services research. In the future, the digitised map will be used as a sampling frame and point of reference for studies on quality and utilisation of PPs in Ujjain district. However, the utility for health care planning is less clear. GIS has limitations in countries like India due to lack of valid routine data to enter into GIS as well as to competing demand for health care resources.
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| 5. |
- Hultberg, Eva-Lisa, 1952, et al.
(author)
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Co-financing as a means to improve collaboration between primary health care, social insurance and social service in Sweden. A qualitative study of collaboration experiences among rehabilitation partners.
- 2003
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In: Health policy (Amsterdam, Netherlands). - 0168-8510. ; 64:2, s. 143-52
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Journal article (peer-reviewed)abstract
- Collaboration between services has often been suggested as a means to increase effectiveness and reduce costs especially in the care and rehabilitation of long-term illness. In Sweden, a special legislation named SOCSAM was introduced in 1994, enabling financial collaboration between governmental and municipal authorities. In this paper we report on a qualitative study on collaboration around patients with musculoskeletal diseases. The aim of the study was to assess differences in goal formulation, collaboration and communication between staff in intervention health centres that have implemented co-financing projects and health centres working under conventional conditions. Focus group interviews were performed with staff at intervention and control health care centres. We found that the interdisciplinary collaboration had improved in the intervention health care centres compared to the controls. Our findings suggest that co-financing can enhance development of better forms of interdisciplinary and interorganisational collaboration through legitimising formulation of common long-term goals, while emphasising mutual benefits.
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| 6. |
- Hultberg, Eva-Lisa, 1952, et al.
(author)
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Effects of a co-financed interdisciplinary collaboration model in primary health care on service utilisation among patients with musculoskeletal disorders.
- 2007
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In: Work (Reading, Mass.). - 1051-9815. ; 28:3, s. 239-47
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Journal article (peer-reviewed)abstract
- BACKGROUND: In 1994 Sweden introduced a trial legislation allowing co-financing between authorities. The legislation aimed to stimulate new ways of collaboration between health and social care providers. One of the specific objectives was to make management of patients with conditions requiring multidisciplinary care more efficient and reduce costs. This study aims to assess if there were any differences in management of patients with musculoskeletal disorders at health centres applying the trial legislation compared to health centre with conventional care with regards to health services utilisation, health care interventions received, and costs. METHOD: A comparative prospective study was conducted. Consecutive patients aged 16-64 with musculoskeletal disorders attending the health care centres with (n=107) and without (n=31) co-financing model were interviewed at inclusion and after 6 and 12 months. Number of contacts with professionals and interventions received were registered. RESULTS: Patients at the intervention centres had significantly more contact with physiotherapists and physicians than the controls. Contacts with other services such as social insurance office, social services office or hospitals did not differ significantly between the groups. Costs were higher for the interventions centres. CONCLUSION: The findings do not suggest that the trial legislation reduced health care utilisation or costs for patients with musculoskeletal disorders.
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| 7. |
- Hultberg, Eva-Lisa, 1952, et al.
(author)
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Effects of co-financed interdisciplinary teamwork on sick leave for people with musculoskeletal disorders.
- 2006
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In: Work (Reading, Mass.). - 1051-9815. ; 26:4, s. 369-77
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Journal article (peer-reviewed)abstract
- AIMS: The aim of the study was to assess if health care centres with a co-financing model for collaborative rehabilitation between primary health care, sickness insurance offices and social welfare offices reduced sick leave among persons with musculoskeletal disorders compared to health centres with conventional rehabilitation structures. METHOD: A comparative prospective study was conducted. Consecutive patients aged 16-64 with musculoskeletal disorders attending the health care centres with (n=107) and without (n=31) co-financing model were interviewed. In addition, we collected register data about patients' allowances for sick leave days for totally 18 months. RESULTS: The intervention group had an average of 94 days and the controls 87 days on sick leave during the 12-months period after inclusion in the study. At 12 months the proportion of patients sick listed was 31% in the intervention group and 32% in the control group. CONCLUSION: The study could not show that the co-financing model reduced the numbers of sick leave days among patients with musculoskeletal disorders. A possible explanation for the lack of positive impact on patients' health or work ability might be that the working procedure has in fact not really been changed and the tool mix lack solid evidence. The study identifies some methodological problems addressed in future research trying to link organisational changes with patient outcomes.
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| 8. |
- Hultberg, Eva-Lisa, 1952, et al.
(author)
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Evaluation of the effect of co-financing on collaboration between health care, social services and social insurance in Sweden.
- 2002
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In: International journal of integrated care. - : Ubiquity Press, Ltd.. - 1568-4156. ; 2
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Journal article (peer-reviewed)abstract
- In this paper, we present an ongoing research project aimed to determine the impact of co-financing on collaboration around patients with musculoskeletal disorders. A trial legislation that allows the social insurance, social services and health care services to unite in co-financing under joint political steering has been tested in different areas in Sweden. In a series of studies, we compare collaboration processes and health outcome for patients with musculoskeletal disorders between health centres with co-financing projects and control health centres without co-financing projects. In this paper the studies are described and some preliminary results are discussed.
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| 9. |
- Hultberg, Eva-Lisa, 1952, et al.
(author)
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Interdisciplinary collaboration between primary care, social insurance and social services in the rehabilitation of people with musculoskeletal disorder: effects on self-rated health and physical performance.
- 2005
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In: Journal of interprofessional care. - : Informa UK Limited. - 1356-1820 .- 1469-9567. ; 19:2, s. 115-24
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Journal article (peer-reviewed)abstract
- Previous research shows there can be good results from co-financing between welfare sectors on the perceived quality of interprofessional collaboration. However, little is known about the impact on patient outcome of such schemes. This study aimed to assess whether co-financed teams with personnel from primary care, social insurance and social services have any effect on patients' health status. A comparative study of patients attending health care centres with and without a co-financed collaboration model was carried out. Although research has shown positive results from co-financed collaboration on staff and organization, we could not find that this new interdisciplinary team structure gave a better patient health outcome than conventional care.
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| 10. |
- Hultberg, Eva-Lisa, 1952, et al.
(author)
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Using pooled budgets to integrate health and welfare services: a comparison of experiments in England and Sweden.
- 2005
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In: Health & social care in the community. - : Hindawi Limited. - 0966-0410 .- 1365-2524. ; 13:6, s. 531-41
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Journal article (peer-reviewed)abstract
- The lack of collaboration between health, social and other welfare services is believed to impair efficiency and reduce effectiveness in addressing the complex problems of patients. Differences in funding streams, political accountabilities, organisational structures and professional cultures are all alleged to contribute to barriers between services. Drawing on their respective evaluations, this paper describes experiments in England and Sweden that use pooled budgets between services to improve interagency and interprofessional collaboration and presents evidence on their impact. Despite differences in the funding and organisation of health and welfare services in each country, some similar conclusions are reached. Among senior managers and politicians, budget pooling broadened their awareness of interdependencies with other agencies and professionals in promoting patients' welfare. However, these broadened perspectives were not immediately shared by professionals working at the front line, with whom patients had immediate contact. Moreover, neither experiment yielded unequivocal evidence of improved cost-effectiveness or of the benefits of budget pooling on the outcomes for service users. These experiments also raise questions about the equity and accountability of welfare services because in both countries only a limited range of services has been integrated under the umbrella of the pooled budgets.
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