Nordic Journal of Health Economics最新文献

{"title":"GP Recruitment and retention in the Nordic countries","authors":"Ole Kristian Aars, O. Kaarboe","doi":"10.5617/njhe.8560","DOIUrl":"https://doi.org/10.5617/njhe.8560","url":null,"abstract":"Demographic changes and decentralization of health care provision have led to a higher demand for General Practitioners (GP) services in the Nordics. As a result, many countries report that recruiting and retaining GPs are increasingly difficult. Coupled with younger GPs increasingly valuing work/life balance, the Nordic countries are now looking at different policies that can ensure a sustainable GP supply going forward. Relevant policy measures depend on the GP systems in place, which also differs between the countries. We provide an overview of reforms and policies that have been planned or implemented in the last 10 years and use a theoretical framework to discuss their potential effects on recruitment and effort. Our focus is on remuneration schemes, GPs’ working conditions and practice quality as policy levers to incentivize effort and to attract additional GPs. We show that policies that have a positive effect on recruiting GPs can have a negative effect on the effort GPs exert. Since reduced effort might have a negative effect on the services patients receive, the total effects of the policies are uncertain. We further show that the dominating effect is sensitive to preferences and characteristics of the GPs, providing important insights for policy makers who want to increase GP supply.","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80390613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of occupational health care in ambulatory health care in Finland","authors":"Tuukka Holster, L. Nguyen, U. Häkkinen","doi":"10.5617/njhe.8561","DOIUrl":"https://doi.org/10.5617/njhe.8561","url":null,"abstract":"In Finland, occupational healthcare (OHC) provides alternative access to curative ambulatory primary healthcare for a large proportion of the employed. Providers of occupational and private healthcare can also refer patients to public secondary healthcare, possibly providing better access to specialized medicine. We investigate the determinants of the use of OHC and associations between the use of OHC and other ambulatory service sectors and distributions of ambulatory healthcare. We find that the probability of using OHC is positively associated with the size of the employing organization and is higher for those with higher incomes but does not vary strongly between patients with different health conditions. Those who use OHC visit public health centres less often, but the negative association is not strong: the use of occupational healthcare seems to be associated with an overall higher use of ambulatory services. The results show that ambulatory healthcare is not allocated according to need in Finland. Those with higher incomes are in better health and use more OHC and private healthcare.\u0000Published: Online July 2022","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90518562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Work pressure and job dissatisfaction: Challenges in Danish general practice","authors":"A. Oxholm, T. Allen, D. Gyrd-Hansen, D. Jarbøl, R. V. Sydenham, L. Pedersen","doi":"10.5617/njhe.8319","DOIUrl":"https://doi.org/10.5617/njhe.8319","url":null,"abstract":"A main objective of the Nordic healthcare systems is to deliver timely and equal access to high-quality healthcare to the entire population. Health care providers, such as general practitioners (GPs), may therefore experience pressure to deliver care from both the health authorities and patients. However, if GPs’ gains do not outweigh their costs of providing the demanded care, it may lead to job dissatisfaction and thereby potentially to poorer quality of care. This study contributes to the literature by estimating the association between different sources of experienced work pressure and job dissatisfaction among GPs. We use data from a nation-wide survey of Danish GPs distributed in 2019. The study includes six items covering GPs’ experienced work pressure, which we categorise based on the degree to which they are related to demands from either patients or health authorities. Using a series of ordered logit models with a rich set of explanatory variables, we estimate the association between the pressure measures and GP job dissatisfaction. We find that GPs reporting high or considerable work pressure have an increased likelihood of also reporting job dissatisfaction. However, we find considerable heterogeneity in this relationship across different sources of work pressure as well as across GP, practice, and area characteristics. For example, the relationship between pressure from patients’ demands for consultations and job dissatisfaction is stronger among GPs practicing in areas with an undersupply of GPs. Solo practitioners, who cannot share their administrative burdens with colleagues, experience a stronger association between pressure from the health authorities and job dissatisfaction. Policymakers should consider this heterogeneity when implementing new schemes and organisational structures affecting GPs’ work pressure.\u0000Published: Online January 2022.","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82446733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using matching methods to account for selection bias in Norway’s Primary Care Teams (PCT) pilot","authors":"Øyvind Snilsberg","doi":"10.5617/njhe.8562","DOIUrl":"https://doi.org/10.5617/njhe.8562","url":null,"abstract":"Norway is piloting team-based primary care delivery models: Honorarmodellen (HM) and Driftstilskuddsmodellen (DM). In addition to organisational changes, the DM transforms provider payment, which seems to attract specific practices. This, coupled with the small number of DM practices, makes it difficult to produce credible evidence regarding the model and its effects on health system performance. I examine whether matching methods—specifically, coarsened exact matching, propensity score matching, and propensity score weighting—can improve evaluation in this demanding situation. As in previous studies on the small sample performance of matching methods, I find no clear best method. This suggests using propensity score weighting, which does not discard data. In the final section of the article, I offer additional advice to help improve the evaluation in similar situations.","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88580369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life in the Swedish General Population During COVID-19 - Based on pre- and post-pandemic outbreak measurement","authors":"S. Olofsson, U. Persson, N. Y. Gu, C. Gong, X. Jiao, J. Hay","doi":"10.5617/NJHE.8332","DOIUrl":"https://doi.org/10.5617/NJHE.8332","url":null,"abstract":"The outbreak of the pandemic COVID-19 (Coronavirus) has resulted in various international and national strategies, including non-pharmaceutical interventions (NPIs) such as social distancing and travel bans, which have purportedly mitigated the health loss due to the pandemic but also given rise to a severe economic crisis. Both factors, the pandemic and the NPIs, can be expected to have an impact on the Health-Related Quality-of-Life (HRQoL) of the population. The objective of this study was to estimate the impact on HRQoL of the Swedish adult population during the outbreak of the COVID-19 pandemic. A web-based survey was sent to randomised samples of the adult Swedish population before the outbreak of the pandemic in Sweden in February 2020 (n=1,016) and during the outbreak of the pandemic. The first wave pandemic data was collected in April 2020 (n=1,003), one-month after the outbreak and, the second wave data was collected in January 2021 (n=1,013), after 10-months living under the pandemic. HRQoL was measured using the EQ-5D-5L in the pandemic surveys, whereas the Visual Analogue Scale (VAS) was used in all surveys. The results suggested a reduction in average HRQoL as measured by VAS in the adult Swedish population, with 0.059 points reduction in VAS in April 2020 and 0.074 points reduction in January 2021, compared to the pre-pandemic measurement in February 2020.  The loss in HRQoL was significant among respondents in the working age population (<65 years), suggesting that the social and economic impact of NPIs were the primary drivers for this specific cohort. Findings of this study supports a wide public health perspective and future HRQoL measurements at the population level throughout the pandemic.\u0000Published: Online September 2021","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87602665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What matters for patients’ experiences with primary care? A study of variation in patient reported experience measures with regard to structural and organisational characteristics of primary care centres in a Swedish region.","authors":"A. Glenngård","doi":"10.5617/NJHE.8030","DOIUrl":"https://doi.org/10.5617/NJHE.8030","url":null,"abstract":"Previous research on variation in patient reported experience measures (PREMs) suggest that it is important to be cautious when using comparative information about patients’ experiences, collected via patient surveys, to assess provider performance. Not all factors associated with variation in PREMs are related to factors that providers themselves can control. This study explores if structural characteristics of primary care practices (PCCs), that are difficult to control, and the way that providers manage and organise their work matter for patients’ experiences with care. The purpose was to analyse variation in PREMs at the PCC level in Swedish primary care, with regard to structural characteristics of PCCs, including patient mix, and variables representing how providers organise and manage their work. Since the choice reform in 2007-2010, there is a mix of public and private providers, all with public funding and operating under the same overall requirements. The analysis is based on data from a national patient survey in primary care and registry data from a large Swedish region. OLS regression analysis was used to study variation in seven PREM-dimensions in regards to variables representing structural and organisational characteristics and processes of work at PCCs, covering the years 2018-2019 (N=281 PCC year observations). The results imply that variables that can be changed by providers themselves matter more for patients’ experiences with care than factors that providers cannot control. The most significant associations were found between PREMs and proportion and continuity of GP visits and adherence to clinical guidelines regarding treatment of risk groups. However, it is a challenge for providers to offer a high proportion of visits with GPs and good continuity due to a persisting shortage of GPs in Sweden. Recent policy initiatives have been introduced in this area. From a policy perspective, variation in patients’ experiences with regard to socioeconomic conditions is also a concern.\u0000Published: Online August 2021\u0000 ","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87665104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of new PhDs in the Nordic countries","authors":"Margareta Dackehag","doi":"10.5617/njhe.7922","DOIUrl":"https://doi.org/10.5617/njhe.7922","url":null,"abstract":": The aim of this Ph.D. thesis was to investigate whether patient involvement in medication management during hospitalisation affects the number of dispensing errors, participants’ perceptions regarding medication and participant satisfaction, and whether self-administration of medication (SAM) offers health economic advantages. Study 1 was a feasibility and pilot study about methodological, procedural and clinical uncertainties concerning the intervention and study design. This study showed that it was feasible to perform a pragmatic randomised controlled trial (RCT) on SAM’s effects. Only minor adjustments to the intervention, exclusion criteria, recruitment procedure and outcome measures, including time measurements, were needed. Recruitment was considered satisfactory, outcome-measurement methods worked as expected and the intervention was well-accepted among patients. In Study 2, we performed a pragmatic RCT that investigated whether SAM during hospi talisation affected the number of dispensing errors and participants’ perceptions regarding medication and satisfaction. Modified disguised observation was used to observe nurses and participants when they dispensed medication. The Beliefs about Medicines Questionnaire was used to explore participants’ perceptions regarding medication. Altogether, 250 participants were recruited, and just over 1,000 opportunities for errors were observed in each study group. The study found statistically significantly fewer dispensing errors in the self-administering group; thus, letting patients self-administer their medication during hospitalisation did not compromise safety related to medication dispensing. At follow-up, participants from the intervention group perceived fewer concerns about their medication, generally found medication to be less harmful and were more satisfied with the way they received medication during hospitalisation compared with the control group. Also at follow-up, fewer deviations existed in the medication list in the intervention group compared with that of the control group. In Study 3, we performed a cost-consequence analysis of SAM. We performed a cost analysis at micro-costing level using a hospital perspective with a short-term incremental costing approach. Resource use and cost data were collected alongside the RCT study, including a study of nursing time used on dispensing, administration, SAM start-up and discharge preparation. Results from the RCT study and information on the number of readmissions and general practitioner contacts within 30 days after discharge were selected as consequences. The cost analysis showed, on average, a lower total cost per participant in the intervention group compared with that of the control group. As SAM favoured the intervention group with respect to most outcomes, the intervention was suggested to be cost-effective. Abstract: Health- economic evaluation, or simply ‘economic evaluation’, has now been applied to healthcare for over 50 years, ","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"16 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72476621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What should guide priority setting in health care? A study of public preferences in Sweden","authors":"Linda Ryen, N. Jakobsson, M. Svensson","doi":"10.5617/njhe.6159","DOIUrl":"https://doi.org/10.5617/njhe.6159","url":null,"abstract":"Priority setting criteria in health care are commonly set by politicians on behalf of the public. It is desirable that these criteria are in line with societal preferences in order to gain acceptance for decisions on what health services to provide and reimburse. We study public preferences for the allocation of the health care budget based on age, disease severity and treatment cost. We use data from a web survey where 1,160 respondents provided their views on priority setting criteria in health care. The data was analyzed using multinomial logistic regression analyses and one-sample proportion tests. Between 13 to 25 percent of the respondents agree that age, disease severity and treatment cost are valid criteria for priority setting, whereas 56 to 80 percent support weaker versions of the statements. We also find significant differences within the population; young men are for example more prone to support explicit priority setting criteria. Our results imply a need for trade-offs in health care priority setting if balancing differing preferences among population groups. To achieve a greater understanding for priority setting in general, and for using economic reasoning in particular, there may be a need for more public transparency to make clear that priority setting is inevitable. \u0000Published: Online December 2019","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77678574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social and geographical inequalities in the choice of foot therapy as preventive care: A nationwide registry study on Danish people with diabetes","authors":"C. Halling, J. Ladenburg","doi":"10.5617/njhe.5914","DOIUrl":"https://doi.org/10.5617/njhe.5914","url":null,"abstract":"Diabetic foot ulcers are a serious complication of diabetes with high costs and adverse sequelae, such as lower-extremity amputations. International guidelines recommend that all people with diabetes should have their feet inspected at least once a year. This study is aimed at determining whether socioeconomic factors influence the probability of having the feet inspected by a chiropodist on a nationally representative sample of people with diabetes. We estimate a logit model for the choice determinants of foot inspections among people with diabetes. Of all people with diabetes, 73% have not had their feet inspected by a chiropodist. The results indicate social and geographical inequality with regard to diabetic foot care. Especially for ethnic minorities, people with low income and people living in rural and remote areas. The findings are robust to a series of sensitivity analyses.Published: Online October 2019.","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78011471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of higher education on body weight","authors":"Jane Greve, C. Weatherall","doi":"10.5617/NJHE.5941","DOIUrl":"https://doi.org/10.5617/NJHE.5941","url":null,"abstract":"A large and growing body of literature has examined the causal impact of schooling on health and health behaviors. Most of this research exploits changes in education due to compulsory schooling requirements and thus the effect is estimated at a margin—one more year of schooling—at the lower end of the education distribution. This paper is the first paper to estimate the causal effect of higher education, i.e., more than two years in addition to 12 years of primary and secondary education (e.g., a Bachelor of Art degree or a Master of Art degree), on body weight. To identify the causal effect we exploit a reform of the Danish student’s grant scheme in 1988, which involved a grant increase of approximately 60% and apply an instrumental variable approach. The grant scheme covers students’ costs of living throughout their college education. We found that completing a higher education significantly reduced the probability of being overweight (Body Mass Index >25) among men. This effect is identified for a group of people that are much more likely to come from a low income background.A large and growing body of literature has examined the causal impact of schooling on health and health behaviors. Most of this research exploits changes in education due to compulsory schooling requirements and thus the effect is estimated at a margin—one more year of schooling—at the lower end of the education distribution. This paper is the first paper to estimate the causal effect of higher education, i.e., more than two years in addition to 12 years of primary and secondary education (e.g., a Bachelor of Art degree or a Master of Art degree), on body weight. To identify the causal effect we exploit a reform of the Danish student’s grant scheme in 1988, which involved a grant increase of approximately 60% and apply an instrumental variable approach. The grant scheme covers students’ costs of living throughout their college education. We found that completing a higher education significantly reduced the probability of being overweight (Body Mass Index >25) among men. This effect is identified for a group of people that are much more likely to come from a low income background.Published: Online August 2019.","PeriodicalId":30931,"journal":{"name":"Nordic Journal of Health Economics","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79867753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}