Suchergebnisse

This article considers how a specific need‐based resource allocation formula for children's day care, income support, child welfare and other social services was developed. The formula is needed for the municipal allocation of state subsidies for social services, and the work was performed for the Ministry of Social Welfare and Health. Cross‐sectional data were collected from the 436 Finnish municipalities and 37 small areas within the six largest cities. Because of the simultaneous relationship between supply and demand of services, two‐stage least‐square estimation and structural equations models were used in the analysis. After the effect of supply was removed from the service utilisation data, group‐need factors (municipal variables) were found for these services. The new formula is financially and administratively feasible, transparent and reasonably simple.

Individual characteristics and socioeconomic position (SEP) are important determinants of health differences. We (1) examine the association of demography and SEP, with perceived health of the Russian population, and (2) quantify the magnitude of health inequalities ascribed to SEP in the Russian Federation. We apply a random effect Generalized Least Squares model on the datasets of the Russian Longitudinal Monitoring Survey (RLMS: 1994–2013). Our measure of health inequality is concentration index (CI), which we decompose into the determinants of health inequalities. Further, a balanced sample of 1,496 individuals extracted from the 1994 wave of RLMS is followed over 19-year period. The degree of aversion to inequalities in perceived health between the worseoff and the better-off is measured with achievement index. Being employed matters in perceiving a better health. Although the perceived health differences between the better-off and the worse-off are reduced, health inequality index indicates a change for better health for the better-off Russians.

Abstract Background In Finland like in many other countries, employers are legally obliged to organize occupational health services (OHS) for their employees. Because employers bear the costs of OHS it could be that in spite of the legal requirement OHS expenditure is more determined by economic performance of the company than by law. Therefore, we explored whether economic performance was associated with the companies' expenditure on occupational health services. Methods We used a prospective design to predict expenditure on OHS in 2001 by a company's economic performance in 1999. Data were provided by Statistics Finland and expressed by key indicators for profitability, solidity and liquidity and by the Social Insurance Institution as employers' reimbursement applications for OHS costs. The data could be linked at the company level. Regression analysis was used to study associations adjusted for various confounders. Results Nineteen percent of the companies (N = 6 155) did not apply for reimbursement of OHS costs in 2001. The profitability of the company represented by operating margin in 1999 and adjusted for type of industry was not significantly related to the company's probability to apply for reimbursement of the costs in 2001 (OR = 1.00, 95%CI: 0.99 to 1.01). Profitability measured as operating profit in 1999 and adjusted for type of industry was not significantly related to costs for curative medical services (Beta -0.001, 95%CI: -0.00 to 0.11) nor to OHS cost of prevention in 2001 (Beta -0.001, 95%CI: -0.00 to 0.00). Conclusion We did not find a relation between the company's economic performance and expenditure on OHS in Finland. We suppose that this is due to legislation obliging employers to provide OHS and the reimbursement system both being strong incentives for employers.

Abstract Background Both social and ethical arguments have been used to support preventive occupational health services (OHS). During the 1990s it became more common to support political argumentation for occupational health and safety by converting the consequences of ill health at work into monetary units. In addition, OHS has been promoted as a profitable investment for companies, and this aspect has been used by OHS providers in their marketing. Our intention was to study whether preventive occupational health services positively influence a company's economic performance. Methods We combined the financial statements provided by Statistics Finland and employers' reimbursement applications for occupational health services (OHS) costs to the Social Insurance Institution. The data covered the years 1997, 1999 and 2001 and over 6000 companies. We applied linear regression analysis to assess whether preventive OHS had had a positive influence on the companies' economic performance after two or four years. Results Resources invested in preventive OHS were not positively related to a company's economic performance. In fact, the total cost of preventive OHS per turnover was negatively correlated to economic performance. Conclusion Even if OHS has no effect on the economic performance of companies, it may have other effects more specific to OHS. Therefore, we recommend that the evaluation of prevention in OHS should move towards outcome measures, such as sickness absence, disability pension and productivity, when applicable, both in occupational health service research and in practice at workplaces.

Objective. This systematic review synthesizes the evidence on the cost-effectiveness of population-level interventions to promote physical activity. Data Source. A systematic literature search was conducted between May and August 2013 in four databases: PubMed, Scopus, Web of Science, and SPORTDiscus. Study Inclusion and Exclusion Criteria. Only primary and preventive interventions aimed at promoting and maintaining physical activity in wide population groups were included. An economic evaluation of both effectiveness and cost was required. Secondary interventions and interventions targeting selected population groups or focusing on single individuals were excluded. Data Extraction. Interventions were searched for in six different categories: (1) environment, (2) built environment, (3) sports clubs and enhanced access, (4) schools, (5) mass media and community-based, and (6) workplace. Data Synthesis. The systematic search yielded 2058 articles, of which 10 articles met the selection criteria. The costs of interventions were converted to costs per person per day in 2012 U.S. dollars. The physical activity results were calculated as metabolic equivalent of task hours (MET-hours, or MET-h) gained per person per day. Cost-effectiveness ratios were presented as dollars per MET-hours gained. The intervention scale and the budget impact of interventions were taken into account. Results. The most efficient interventions to increase physical activity were community rail-trails ($.006/MET-h), pedometers ($.014/MET-h), and school health education programs ($.056/MET-h). Conclusion. Improving opportunities for walking and biking seems to increase physical activity cost-effectively. However, it is necessary to be careful in generalizing the results because of the small number of studies. This review provides important information for decision makers.

L'évaluation des coûts de la maladie d'Alzheimer est un exercice difficile, a fortiori pour une comparaison européenne. Comment peut-on définir ces coûts, et comment les mesurer, notamment lorsque les systèmes de prise en charge ou de remboursement varient, ou lorsque les données sont totalement inexistantes dans certains pays ? Le groupe socio-économie du projet EuroCoDe (European Collaboration on Dementia, projet financé par la Commission européenne dans le cadre du programme d'action communautaire en santé publique 2003-2008, initié et coordonné par Alzheimer Europe et soutenu par la Fondation Médéric Alzheimer) a construit un modèle économique des coûts de la maladie, faisant intervenir différentes hypothèses, approximations et options, à partir des données économiques disponibles identifiées dans la littérature internationale. Le coût total de la maladie d'Alzheimer ou d'une maladie apparentée en Europe (UE 27) est estimé à 160,3 milliards d'euros en 2008 (1,3% du produit intérieur brut 2008 de l'UE 27 * ), dont 71,7 milliards en coûts directs (45%) et 88,6 milliards (55%) en coûts indirects. Les coûts annuels par personne atteinte de la maladie d'Alzheimer sont estimés à 22 194 €, dont 9 925 € en coûts directs et 12 270 € en coûts indirects. Pour la zone UE 27, le poids de la maladie est estimé à 2,12 millions d'années de vie ajustées à l'incapacité (441 années de vie ajustées à l'incapacité pour 100 000 personnes). Ce poids est supérieur à celui du diabète.