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This paper explores the relationship between the regional unemployment rate and total and cause-specific mortality in Sweden during 1976-2005. Overall mortality is unrelated to changes in the unemployment rate, while the biggest cause of death (heart disease) decreases when the unemployment rate decreases. At the same time other accidents, including job-related accidents, increase when the unemployment rate decreases. Swedish evidence provides no support for the US research findings that short-term increases in the unemployment rate are bad for your health in general.

Economic evaluations are an important input to decision-making and priority-setting in the health care sector. Measuring preferences for health improvements, as the demand-side value (willingness to pay) of gaining a quality-adjusted life year (QALY), is one relevant component in the interpretation of the results from health economic evaluations. Our article addresses whether willingness to pay for a QALY (WTP-Q) is sensitive to the size of the health differences and the probability for improvement. We use data from a contingent valuation survey based on 1400 respondents conducted in the spring of 2014. The results show that the expectation of sensitivity to scope, or higher WTP to the larger expected quality of life improvement, is not supported. We find WTP-Q values that conform reasonably well to previous studies in Sweden.

Background The entire population of Mongolia has free access to primary health care, which is fully funded by the government. It is provided by family health centers in urban settings. In rural areas, it is included in outpatient and inpatient services offered by rural soum (district) health centers. However, primary health care utilization differs across population groups. The aim of this study was to evaluate income-related inequality in primary health care utilization in the urban and rural areas of Mongolia. Methods Data from the Household Socio-Economic Survey 2012 were used in this study. The Erreygers concentration index was employed to assess inequality in primary health care utilization in both urban and rural areas. The indirect standardization method was applied to measure the degree of horizontal inequity. Results The concentration index for primary health care at family health centers in urban areas was significantly negative (−0.0069), indicating that utilization was concentrated among the poor. The concentration index for inpatient care utilization at the soum health centers was significantly positive (0.0127), indicating that, in rural areas, higher income groups were more likely to use inpatient services at the soum health centers. Conclusions Income-related inequality in primary health care utilization exists in Mongolia and the pattern differs across geographical areas. Significant pro-poor inequality observed in urban family health centers indicates that their more effective gatekeeping role is necessary. Eliminating financial and non-financial access barriers for the poor and higher need groups in rural areas would make a key contribution to reducing pro-rich inequality in inpatient care utilization at soum health centers. ; published version ; peerReviewed

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

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.

Background: Differences in health care utilization across geographical areas are well documented within several countries. If the variation across areas cannot be explained by differences in medical need, it can be a sign of inefficiency or misallocation of public health care resources. Methods: In this observational, longitudinal panel study we use regional level data covering the 21 Swedish regions (county councils) over 13 years and a random effects model to assess to what degree regional variation in outpatient physician visits is explained by observed demand factors such as health, demography and socio-economic factors. Results: The results show that regional mortality, as a proxy for population health, and demography do not explain regional variation in visits to primary care physicians, but explain about 50% of regional variation in visits to outpatient specialists. Adjusting for socio-economic and basic supply-side factors explains 33% of the regional variation in primary physician visits, but adds nothing to explaining the variation in specialist visits. Conclusion: 50-67% of regional variation remains unexplained by a large number of observable regional characteristics, indicating that omitted and possibly unobserved factors contribute substantially to the regional variation. We conclude that variations in health care utilization across regions is not very well explained by underlying medical need and demand, measured by mortality, demographic and socio-economic factors.

Government authorities use resources on information campaigns in order to inform citizens about relevant policy changes. The motivation is usually that individuals sometimes are ill- informed about the public policies relevant for their choices. In a survey experiment where the treatment group was provided with public information material on the social security system, we assess the short- and medium-term knowledge effects. We show that the short run effects of the information on knowledge disappear completely within 4 months. The fi ndings illustrate the limits of public information campaigns to improve knowledge about relevant policy reforms.

Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the "value for money." The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to "status quo" (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts

Background: Patients with cervical radiculopathy often have neck- and arm pain, neurological changes, activity limitations and difficulties in returning to work. Most patients are not candidates for surgery but are often treated with different conservative approaches and may be sick-listed for long periods. The purpose of the current study is to compare the effectiveness of neck- specific training versus prescribed physical activity. Methods/Design: The current protocol is a two armed intervention randomised clinical trial comparing the outcomes of patients receiving neck specific training or prescribed physical activity. A total of 144 patients with cervical radiculopathy will be randomly allocated to either of the two interventions. The interventions will be delivered by experienced physiotherapists and last 14 weeks. The primary outcome variable is neck- and arm pain intensity measured with a Visual Analogue Scale accompanied with secondary outcome measures of impairments and subjective health measurements collected before intervention and at 3, 6, 12 and 24 months after base-line assessment. Discussion: We anticipate that the results of this study will provide evidence to support recommendations as to the effectiveness of conservative interventions for patients with cervical radiculopathy. ; Funding Agencies|Swedish Government through the Karolinska Institute; Swedish National School of Research Education in Health Care Sciences; Strategic Research Programme in Care Sciences; Stockholm County Council Funding ALF Medicine

Objective: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective. Design: Cost-effectiveness analysis. Setting: 23 PCCs in two Swedish regions. Participants: Patients with depression (n=342). Main outcome measures: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-angstrom sberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: Cost/QALY and Cost/DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping. Results: Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were Euro368 (healthcare perspective) and Euro6217 (societal perspective) for the intervention patients and Euro246 (healthcare perspective) and Euro7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was Euro6773 (healthcare perspective) and from a societal perspective the CM programme was dominant. Discussion: The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.