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New estimates of the demand for health : Results based on a categorical health measure and Swedish micro data

In this paper we estimate a 'Grossman' model of demand for health based on Swedish micro data. The data set consists of a random sample of over 5000 individuals taken from the Swedish adult population. Health capital is measured by a categorical measure of overall health status, and an ordered probit model is used to econometrically estimate the demand for health equation. The results are consiste

Diagnosing and grading heart failure with tomographic perfusion lung scintigraphy : validation with right heart catheterization

Aims: Pulmonary congestion remains a diagnostic challenge in patients with heart failure (HF). The recommended method, chest X-ray (CXR), lacks in accuracy, whereas quantitative tomographic lung scintigraphy [ventilation/perfusion single-photon emission computed tomography (V/P SPECT)] has shown promising results but needs independent validation. The aim of this study is to evaluate V/P SPECT as a

The demand for health : Results from new measures of health capital

This paper estimates a "Grossman" model of demand for health. We measure health status on a 0 (dead) to 1 (full health) cardinal scale by the rating scale method and the time trade-off method. We also use a categorical measure of overall health status commonly used in quality of life measurements. To estimate the demand for health equations, the Tobit technique is used for the rating scale and tim

A note on validating Wagstaft and van Doorslaer's health measure in the analysis of inequalities in health

The aim of this note is to validate Wagstaff and van Doorslaer's approach of constructing a continuous health measure to be used in the analysis of inequalities in health. We calculate health concentration indices for Uppsala County in Sweden based on three different health status measures: health measured according to the WvD approach based on a self-assessed categorical health measure, health me

The impact of internal markets on health care efficiency : Evidence from health care reforms in Sweden

A purchaser/provider split together with output-based reimbursement were recently introduced by several Swedish county councils. These changes have been motivated by arguments of efficiency and consumer choice. This paper tests the null hypothesis that hospital services are provided as efficiently by county councils with internal markets and output-based reimbursement as by county councils with bu

Direct costs of glaucoma management following initiation of medical therapy. A simulation model based on an observational study of glaucoma treatment in Germany

Background: Economic evaluation of new treatments in the field of glaucoma represents a challenge. In the absence of a clear epidemiological link between intra-ocular pressure (IOP) and disease progression to blindness, the economic impact of treatments that lower IOP on long-term outcome cannot be estimated. As an alternative, effectiveness may be expressed as the ability to control IOP over time

Redistributive effects of Swedish health care finance

This paper investigates the redistributive effects of the Swedish health care financing system in 1980 and 1990 for four different financial sources: county council taxes, payroll taxes, direct payments and state grants. The redistributive effects are decomposed into vertical, horizontal and 'reranking' segments for each of the four financial sources. The data used are based on probability samples

Estimating the costs of hip fracture and potential savings

This paper examines the determinants of hip fracture costs and further evaluates potential savings in costs when the occurrence of hip fracture is prevented. The costs of hip fracture are comprised of direct costs from health care and the social welfare system. Data were collected for 1,080 postmenopausal women admitted from private residence for primary hip fracture surgery during the year of 199

Econometric analysis of variation in cesarean section rates : A cross- sectional study of 59 obstetrical departments in Sweden

The objective of this study was to explain the variation in cesarean section rates among hospitals (obstetrical departments) in Sweden, and to discuss its potential economic consequences. Using data from The Swedish Medical Birth Registry 1991, we made a cross-sectional study of the cesarean section rate at the departmental level. We identified some 20 determinants, demand-related as well as suppl

Presence of chronic diabetic foot ulcers is associated with more frequent and more advanced retinopathy

Aims: To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers. Methods: Visual acuity and fundus imaging were evalua

Equity in the delivery of health care in Sweden

There is mutual agreement that health care should be delivered according to need. In this article, although we employ different specifications for need, we conclude that there is inequity in the delivery of health care in Sweden. Higher income groups visit doctors more often than lower income groups in relation to need, but lower income groups remain in hospital longer once they have been admitted

Costs of treating primary open-angle glaucoma and ocular hypertension : A retrospective, observational two-year chart review of newly diagnosed patients in Sweden and the United States

Purpose: The objective of this study was to investigate what treatment strategies prevail in different countries for patients newly diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH) only and initiated on treatment with beta-blockers, and to estimate the total direct cost of treatment for two years. In addition, differences in costs between and within the countries and t

The effect of changes in treatment patterns on drug expenditure

This paper investigates the effects of changes in drug therapy on drug expenditure in Sweden between 1990 and 1995. Analyses have been carried out for both the aggregate drug expenditure and for drug expenditure according to the main groups of the Anatomical Therapeutic Chemical (ATC) classification system. Changes in expenditure can be divided into 3 components: the price of drugs, the quantity o

Price indices of drugs and the switching to new drugs two empirical examples

Standard price indices may not account for the price decrease that results when patients switch to pharmaceutical products for which their demand-reservation price exceeds the price of the new product. In a similar way, standard price indices may not account for the price increase that results when patients switch to pharmaceuticals for which the reservation price is below the price of the new dru

The determinants of health expenditure in the OECD countries : a pooled data analysis.

This paper uses international health expenditure and the latest OECD data to investigate the determinants of aggregate health expenditure. The study differs from most previous studies in two principal ways. First, it uses a somewhat larger sample for estimation, with pooled time-series, cross-section data for 22 OECD countries for a 20-year period. Most previous work has used a purely cross-sectio

Income-related inequalities in health : Some international comparisons

This paper presents evidence on income-related inequalities in self- assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the

Equity in health care utilization : Further tests based on hurdle models and Swedish micro data

This paper tests the null hypothesis of no horizontal inequity in delivery of health care by use of count data hurdle models and Swedish micro data. It differs from most earlier work in three principal ways: First, the tests are carried out separately for physician and hospital care; second, the tests are carried out separately for the probability of seeking care and the amount of care received (g

The impact of user charges on the consumption of drugs : Empirical evidence and economic implications

Expenditure on drugs is increasing rapidly in many countries, and this has led to increased interest in measures to contain drug expenditure. One measure that has been discussed is to increase user charges for prescription drugs. In this article, we consider whether or not raising user charges decreases the consumption of drugs. We also discuss how to judge if increased user charges for drugs are

Impact of Inhaled Corticosteroids on Acute Asthma Hospitalization in Sweden 1978 to 1991

OBJECTIVES. In clinical studies, it has been found that treating asthmatic patients with inhaled corticosteroids can reduce the need for in-patient care. The purpose of this study was to determine if such a relationship could be observed in available health-care statistics in Sweden and, if such a relationship could be established, what health economic consequences it implied. METHODS. A retrospec

A note on the estimation of the equity-efficiency trade-off for QALYs

In this note the veil of ignorance approach is tested as a basis for empirically determining the shape of the social welfare function for QALYs. An experiment is carried out where the participants choose between different societies that differ with respect to per capita QALYs and the distribution of QALYs. The answers are analyzed using logistic regression analysis, According to the results the re