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.
{"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}
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. Published: Online July 2022
{"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}
A. Oxholm, T. Allen, D. Gyrd-Hansen, D. Jarbøl, R. V. Sydenham, L. Pedersen
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. Published: Online January 2022.
{"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}
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.
{"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}
S. Olofsson, U. Persson, N. Y. Gu, C. Gong, X. Jiao, J. Hay
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. Published: Online September 2021
{"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}
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. Published: Online August 2021
{"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}
: 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,
本博士论文的目的是调查患者在住院期间参与药物管理是否会影响配药错误的数量，参与者对药物的看法和参与者满意度，以及自我给药(SAM)是否提供健康经济优势。研究1是一项可行性和试点研究，涉及干预和研究设计的方法学、程序和临床不确定性。这项研究表明，对SAM的效果进行实用的随机对照试验(RCT)是可行的。只需要对干预、排除标准、招募程序和结果测量(包括时间测量)进行微小的调整。招募被认为是令人满意的，结果测量方法如预期的那样起作用，干预措施在患者中得到了很好的接受。在研究2中，我们进行了一项实用的随机对照试验，调查住院期间的SAM是否会影响配药错误的数量以及参与者对药物和满意度的看法。采用改良变相观察法观察护士和被试配药时的情况。“药物信念问卷”用于调查参与者对药物的认知。总共招募了250名参与者，在每个研究小组中观察到的错误机会超过1000次。研究发现，在统计上，自我给药组的配药错误显著减少;因此，让患者在住院期间自行用药并不影响与药物配药相关的安全性。在随访中，与对照组相比，干预组的参与者较少担心他们的药物治疗，通常发现药物治疗的危害较小，并且对他们在住院期间接受药物治疗的方式更满意。在随访中，干预组的用药清单偏差也比对照组少。在研究3中，我们对SAM进行了成本-后果分析。我们采用短期增量成本法，从医院角度对微观成本进行了成本分析。资源使用和成本数据与RCT研究一起收集，包括护理时间用于配药，给药，SAM启动和出院准备的研究。结果选择了RCT研究的结果以及出院后30天内再入院和全科医生接触次数的信息。成本分析显示，平均而言，与对照组相比，干预组的每个参与者的总成本较低。由于SAM在大多数结果上倾向于干预组，因此建议干预具有成本效益。摘要:健康-经济评价，或简单的“经济评价”，现在已经应用于医疗保健超过50年，有时效果好，有时病。这篇博士论文试图让人们理解“经济评估”能给决策者带来什么，但也开始承认它的问题和陷阱。此外，它采用一种数据驱动的方法进行经济评估，利用芬兰前列腺癌筛查随机研究(FinRSPC)在20年随访后的记录。FinRSPC始于1996年，是一项实用的基于人群的研究，调查前列腺特异性抗原(PSA)检测的邀请，作为大规模筛查前列腺癌的基础，包括对试验中男性的一些影响和医疗费用的调查。摘要:高龄是大多数急慢性疾病、损伤和功能障碍的危险因素，因此也是营养问题的重要危险因素。在瑞典，大量的老年人保健是在病人的家庭环境中进行的，在过去的几十年里，家庭保健已经转变为更先进的医疗保健。本论文的目的是全面描述营养状况及其随时间的变化在老年人接受家庭保健人口。其目的包括提出一个调查和分析老年人营养状况的框架。在家庭保健中心登记时对营养状况进行了研究，并定期随访三年。在2012年至2017年期间，65岁或以上需要家庭医疗保健至少三个月的患者被要求加入该研究，共有69名参与者(64%为女性)。营养状况的数据收集和分析基于所提出的综合功能视角的营养状况评估模型(论文1)。该模型包括四个双向影响营养状况和功能结果的域。 在论文2中，我们得出结论，营养不良、肌肉减少症、虚弱和脱水在人群中非常普遍，最重要的指标是食欲不振和脱水。这在论文3中得到证实，用统计方法分析了营养状况。总共103项营养状况指标减少到19项，建议进行初步调查。此外，本文还实证地证实了论文1中提出的领域内部和领域之间的关系。最后，我们研究了膳食模式，作为其中一个领域的一部分(论文4)。我们发现有迹象表明，每天至少吃一顿大餐(高能量摄入)对每日总能量和蛋白质摄入量的影响大于一天中更多的进食场合。摘要:在几乎任何情况下，财务激励都是影响行为的有效工具，医疗保健也不例外。然而，医疗保健市场是复杂的，其特点是不确定性、信息不对称和多机构联系。一些人认为，财政激励提高了稀缺资源的有效利用，而另一些人则表示，它为意想不到的不道德行为提供了温床。一个运作良好的基于价值的报销方案(VBRP)应促进财政激励与专业价值之间的协调，以确保高效和公平的医疗保健。这篇论文探讨了在瑞典斯德哥尔摩地区选择性脊柱手术的背景下，基于价值的报销的承诺和陷阱。通过使用混合方法，本文探讨了引入基于价值的报销计划产生的激励因素，以及这些激励因素如何影响医疗保健服务的提供。论文一检验了医疗保健提供者在患者报告的结果测量方面的表现，以及关于临床和社会经济因素对病例组合的潜在影响。论文二考察了一个基于价值的报销方案如何影响选择性脊柱手术的成本给第三方付款人。论文三探讨了医疗保健提供者如何感知报销计划的预期激励。论文四探讨了不同专业团体在如何使基于价值的偿还方案制度化方面的作用。结果显示，VBRP对患者报告的结果测量没有影响，但降低了每次手术的平均成本。取消生产上限使医疗保健提供者能够通过手术治疗比以前更多的患者。产量增加了22%，总成本增加了11%。没有发现歧视病情较重病人的迹象。在引入VBRP后，在择期脊柱手术中产生了更高的价值。VBRP的理念与专业价值观是一致的。然而，并非所有的激励措施都被认为是预期的。人们认为，将出院后护理费用降至最低的重点对物理治疗和护理的质量产生了负面影响。总之，设计良好的VBRP有可能通过以下途径促进整体医疗保健观点:1)医疗保健提供者对医疗保健提供负责的程度，增加医疗保健提供者和医学学科之间合作的意愿;2)更好地了解患者医疗保健利用的总体情况;3)挑战医疗保健领域的传统结构和理念，即质量首先取决于医生的表现。然而，也有需要解决的挑战，1)医疗保健提供者和地区卫生当局之间的沟通和后续工作的运作惯例，2)使传统等级组织中的不同专业在平等条件下合作，以及3)创建信息技术系统，以提高透明度并了解报销计划。因此，要使补偿方案的激励措施有意义，保健提供者和地区卫生当局之间的持续沟通至关重要。摘要:在公共资助的医疗保健部门中，健康收益公平最大化是优先考虑的一个重要目标(Costa-font & Cowell, 2019;Lane et al.， 2017)。卫生经济学文献将公平描述为一个多维概念，涉及测量和判断与卫生保健分配相关的不平等(Bobinac等人，2012;Culyer, 2001;Lane et al.， 2017;Williams & Cookson, 2000)。在寻找公平的医疗保健分配时，决策者必须经常处理健康收益最大化和限制不平等之间不可避免的权衡(Olsen, 1997, Ahlert和Schwettmann, 2017)。 为了指导决策者如何找到卫生保健的公平分配，卫生经济学文献的一个分支应用陈述偏好(SP)实验来引出公众的公平偏好
{"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}
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. Published: Online December 2019
{"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}
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.
{"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}
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.
{"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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：