[Show abstract][Hide abstract] ABSTRACT: The objective of this article was to investigate the existence of horizontal inequality in access to care for six categories of elective surgery in a publicly funded system, when care is rationed through waiting lists. Administrative waiting time data on all elective surgeries (n = 4,634) performed in Ostergötland, Sweden, in 2007 were linked to national registers containing variables on socioeconomic indicators. Using multiple regression, we tested five hypotheses reflecting that more resourceful groups receive priority when rationing by waiting lists. Low disposable household income predicted longer waiting times for orthopedic surgery (27%, p < 0.01) and general surgery (34%, p < 0.05). However, no significant differences on the basis of ethnicity and gender were detected. A particularly noteworthy finding was that disposable household income appeared to be an increasingly influential factor when the waiting times were longer. Our findings reveal horizontal inequalities in access to elective surgeries, but only to a limited extent. Whether this is good or bad depends on one's moral inclination. From a policymaker's perspective, it is nevertheless important to recognize that horizontal inequalities arise even though care is not rationed through ability to pay.
International Journal of Health Services 01/2014; 44(1):169-84. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Using data covering 38 countries across the 1965â€“2005 period, this paper shows that former British colonies tend to exhibit higher levels of carbon dioxide emission than other countries.
[Show abstract][Hide abstract] ABSTRACT: The concentration index and decomposition analysis are commonly used in economics to measure and explain socioeconomic inequalities in health. Such analysis builds on the strong assumption that a health production function can be estimated without substantial bias implying that health is caused by socioeconomic outcomes, which is hard to prove. This article contributes to the decomposition literature by applying a twin design to standard decomposition analysis of socioeconomic health inequalities in Sweden. The twin-based decomposition estimates, which control for unobserved endowments at the twin-pair level, are much lower in magnitude than estimates obtained via typical OLS on the same sample. This demonstrates that OLS-based decompositions are severely upward biased due to underlying confounders, exaggerating the contribution of income and education to health inequality, which in turn limits the usefulness of such decompositions for policy purposes.
[Show abstract][Hide abstract] ABSTRACT: We use the Economic Freedom Index (Gwartney, Lawson and Norton 2008) to characterise the institutions of ancient Athens in the fourth century BCE. It has been shown that ancient Greece witness improved living conditions for an extended period of time. Athens in the classical period appears to fare particularly well. We find that economic freedom in ancient Athens is on level with the highest ranked modern economies such as contemporary Hong Kong and Singapore. With the exception of the position of women and slaves, Athens scores high in almost every dimension of economic freedom. Trade was highly important even by current standards. As studies of contemporary societies show institutional quality to be an important determinant of economic growth, this may be one factor in the relative material success of the Athenians.
Journal of Institutional Economics 01/2011; 10(02). · 0.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: At the beginning of June 2010, the conference 'Health. Happiness. Inequality. Modelling the Pathways between Income Inequality and Health' was held in Darmstadt, Germany. Invited speakers and presenters traveled from all over the world; and researchers from several different subdisciplines were represented at the conference. The common denominator of participants was an interest in how societal income inequality affects individual health and life satisfaction. New and fascinating research results were presented and participants engaged in many interesting discussions.
Expert Review of Pharmacoeconomics & Outcomes Research 10/2010; 10(5):497-500. · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In a dynamic Two-Part Model (2 PM), we find the effect of previous smoking on the participation decision to be decreasing with education among Swedish women, i.e. more educated are less state dependent. However, we do not find an analogous effect of education on the conditional intensity of consumption.
Health Economics 09/2010; 20(7):876-81. · 2.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The difficulties in financing healthcare in Sweden will increase in the future. Based on simulations with a dynamic micro-simulation
model (SESIM), where individual healthcare expenditure is a function of inter alia health status, we expect a 30% increase between 2000 and 2040 in the total number of bed days for the whole population, due
mainly to an increasing population of the oldest old. Hence, the ageing of the population is not just an issue of shifting
the cost of dying to older ages. At the same time, the development of new technologies and the way these are disseminated
across patient groups will continue to raise the cost of high-quality care. While there is likely to be some scope for greater
efficiency on the supply side, changes in the institutional structure are unlikely to be drastic and even drastic policies
may have relatively little to offer in practice. Explicitly giving low priority to elderly patients in the way implied by
straightforward QALY calculations or the “fair innings” argument will hardly be accepted by Swedes in general. Hence, in the
absence of politicians with the impact of someone like Alexander the Great, the future seems to have in store longer queues,
greater reliance on private insurance, and political equivocation.
[Show abstract][Hide abstract] ABSTRACT: This paper uses a unique dataset-containing information collected in 2006 on individuals aged 40-79 in 21 countries throughout the world to examine whether individual income, relative income in a reference group, and income inequality are related to health status across middle/low and high-income countries. The dependent variable is self-assessed health (SAH), and as a robustness check, activities of daily living (ADL) are considered. The focus is particularly on assumptions regarding an individual's reference group and on how the estimated relationships depend on the level of economic development. Correcting for national differences in health reporting behavior, individual absolute income is found to be positively related to individual health. Furthermore, in the high-income sample, there is strong evidence that average income within a peer-age group is negatively related to health, thus supporting the relative income hypothesis. In middle/low-income countries, it is instead average regional income that is negatively associated with health. Finally, there is evidence of a negative relationship between income inequality and individual health in high-income countries. Overall, the results suggest that there might be important differences in these relationships between high-income and middle/low-income countries.
Social Science [?] Medicine 11/2009; 70(6):875-85. · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framework for exploring when health-care services contain characteristics that facilitate individual responsibility through private financing. Six attributes for exploring the suitability of private financing for specific health-care commodities are identified: (i) it should enable individuals to value the need and quality both before and after utilization; (ii) it should be targeted toward individuals with a reasonable level of individual autonomy; (iii) it should be associated with low levels of positive externalities; (iv) it should be associated with a demand sufficient to generate a private market; (v) it should be associated with payments affordable for most individuals; and finally, (vi) it should be associated with 'lifestyle enhancements' rather than 'medical necessities'. The tentative framework enables exploration of individual responsibility connected to health care as a heterogeneous group of commodities, and allows policymakers to make decisions on rationing by design rather than default.
Health Economics Policy and Law 10/2009; 5(2):201-23. · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time.
[Show abstract][Hide abstract] ABSTRACT: This paper aims to provide a critical and systematic review of the societal costs of air pollution-related ill health (CAP), to explore methodological issues that may be important when assessing or comparing CAP across countries and to suggest ways in which future CAP studies can be made more useful for policy analysis. The methodology includes a systematic search based on the major electronic databases and the websites of a number of major international organizations. Studies are categorized by origin - OECD countries or non-OECD countries - and by publication status. Seventeen studies are included, eight from OECD countries and nine from non-OECD countries. A number of studies based on the ExternE methodology and the USA studies conducted by the Institute of Transportation are also summarized and discussed separately. The present review shows that considerable societal costs are attributable to air pollution-related health hazards. Nevertheless, given the variations in the methodologies used to calculate the estimated costs (e.g. cost estimation methods and cost components included), and inter-country differences in demographic composition and health care systems, it is difficult to compare CAP estimates across studies and countries. To increase awareness concerning the air pollution-related burden of disease, and to build links to health policy analyses, future research efforts should be directed towards theoretically sound and comprehensive CAP estimates with use of rich data. In particular, a more explicit approach should be followed to deal with uncertainties in the estimations. Along with monetary estimates, future research should also report all physical impacts and source-specific cost estimates, and should attempt to estimate 'avoidable cost' using alternative counterfactual scenarios.
[Show abstract][Hide abstract] ABSTRACT: This paper explores the mutual influence between the institutional development in Athens in the archaic and classical periods and the contemporary changes in economic life. This enhances our understanding of the causes and consequences of institutional change. It is also worth exploring in view of the suggested connections between economic development, markets and democracy. Between 600 and 322 B.C., Athenian society underwent significant institutional change. Rule by a birth aristocracy gave way to (changing) democratic institutions. Political pay was introduced for magistrates, jurors, and assemblymen. Legislation and execution was transferred to the Assembly and to the courts. The nature and extent of taxation changed. In the same period, economic life changed both qualitatively and quantitatively. Trade and specialisation increased, coinage was introduced and self-sufficient farming gradually gave way to reliance on imports and on the market for necessary goods. These changes not only influenced institutional change, they also affected people’s perception of the world. The influence of institutions on the presence and nature of economic transactions is obvious. The influence on institutional change from changes in economic behaviours and outlook seems however potentially equally important.
Journal of Institutional Economics 03/2008; · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study investigated: (a) the cost and change in hospitalizations related to alcohol misuse for the healthcare sector and (b) the effect of distance to the border on alcohol-related hospitalization costs. The first objective was analyzed using descriptive statistics and the second using ordinary least squares regression on aggregated municipality data. The total cost decreased marginally during the study period while the number of patient-cases decreased substantially, presenting evidence of a substitution towards outpatient care. The increase in average treatment cost and the almost constant total cost provide evidence for a societal increase in the burden of alcohol-related diseases. We found a negative effect for distance to Denmark on alcohol-related hospitalization cost for the year 2003. The effect was smaller for 1998, suggesting that the increase in private import quotas during the study period has affected individuals' consumption level and/or consumption pattern. We also found indications that the increase in import quotas lead to a higher cost increase for heavy consumers than for low consumers.
The European Journal of Health Economics 04/2006; 7(1):46-54. · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The TECH research network collected patient-level data on three procedures for treatment of heart attack patients, (catheterization, coronary artery by-pass grafts and percutaneous transluminal coronary angioplasty), for seventeen countries over an eighteen year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the up-take of these technologies. Health care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public integrated health care systems. Central funding of investments was negatively associated with adoption rates. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of these procedures diminishes over time.
[Show abstract][Hide abstract] ABSTRACT: From a beginning of small isolated settlements around 1000 B.C., the city-state (polis) emerged in Greece in the course of four centuries as a political, geographical and judicial unit, with an assembly, council, magistrates and written laws. Using a rational-actor perspective, it is shown how this process was driven by competition among the members of the elite. A crucial ingredient was the gradual consolidation of boundaries, which contributed to population growth, inter-state conflicts, colonisation and competition for power. Variations over time in the conditions for competition explain both the introduction of formal political institutions and their overthrow by tyrants. Copyright Springer Science+Business Media, LLC 2006
Constitutional Political Economy 02/2006; 17(1):31-48.
[Show abstract][Hide abstract] ABSTRACT: Studies have demonstrated that when parents shoulder considerable financial responsibilities, adverse health outcomes may occur. The present study assesses the association between economic stress and self-rated health in a sample of Swedish parents, and especially how this relation is affected by foreign origin and employment status.
A questionnaire was sent to a random sample of 5,600 individuals between the ages of 21 and 81 in Malmö, Sweden. The total response rate was 69%. Among the respondents, 824 were parents having at least one child living at home. The main exposures were such sociodemographic variables as country of origin and employment status, and economic stress. The outcome variable was self-rated health.
Of the parents in the study, the 34.7% coded as exposed to economic stress showed a significantly increased odds ratio for poor self-rated health (OR=3.12, 95% CI: 2.01-4.84) adjusted for age and sex. After controlling for foreign origin and unemployment, the odds ratio remained statistically significant regarding exposure to economic stress (OR=1.94; 1.16-3.23). In the multivariate model, foreign origin and unemployment were also strongly associated with poor self-rated health (OR=1.78, 95% CI: 1.12-2.88; OR=1.67, 95% CI: 1.01-2.75, respectively). The adjusted population-attributable risk for poor self-rated health was estimated to be 27.4% for economic stress, 26.6% for foreign origin, and 16.7% for unemployment.
Parental economic stress was associated with low self-rated health to a statistically significant degree, even when accounting for employment status and foreign origin. It, therefore, deserves to be seriously considered as an potential public health risk factor among Swedish families.
The European Journal of Public Health 01/2005; 14(4):354-60. · 2.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Around 600 B.C., Athens was ruled by a birth aristocracy. Some 150 years later, the city-state was a “democracy”. A rational-actor perspective, as perceived in the new institutional economics, sheds additional light on this intriguing transformation by focussing our attention on the incentives of individual actors, for example. Furthermore, it illustrates the unpredictable nature of the long-run consequences of institutional change. Repeatedly, a result of the intra-elite competition for power was that members of the elite unwittingly contributed to the changes that eventually undermined their own dominant position as a group.
Lund University, Department of Economics, Working Papers. 01/2004;
[Show abstract][Hide abstract] ABSTRACT: The concept of disability-adjusted life years (DALYs) has rapidly gained in popularity in health policy, and considerable research resources are being allocated to this field. Proponents of DALYs suggest that the measure can be used both as a "gross domestic product of health" and to help in setting priorities in health policy. This study investigates the usefulness of DALYs and contends that DALYs, as the measure is currently understood, cannot be used for either of these two purposes. The DALYs procedure does not produce a useful measure of population health, and its use in priority setting is ethically questionable.
The European Journal of Health Economics 10/2003; 4(3):195-202. · 2.10 Impact Factor