Jes Søgaard

Publications of Jes Søgaard

• Something is amiss in Denmark: a comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente.

  Authors: Michaela Schiøtz, Mary Price, Anne Frølich, Jes Søgaard, Jette K Kristensen, Allan Krasnik, Murray N Ross, Finn Diderichsen, John Hsu

  BMC health services research. 12/2011; 11:347.

  As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas forAs many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems. Using a historical cohort study design, age and gender adjusted population rates of hospitalisations for angina, heart failure, chronic obstructive pulmonary disease, and hypertension, plus rates of 30-day readmission and mortality were investigated for all individuals aged 65+ in the DHS and KP. DHS had substantially higher rates of hospitalisations, readmissions, and mean lengths of stay per hospitalisation, than KP had. For example, the adjusted angina hospitalisation rates in 2007 for the DHS and KP respectively were 1.01/100 persons (95%CI: 0.98-1.03) vs. 0.11/100 persons (95%CI: 0.10-0.13/100 persons); 21.6% vs. 9.9% readmission within 30 days (OR = 2.53; 95% CI: 1.84-3.47); and mean length of stay was 2.52 vs. 1.80 hospital days. Mortality up through 30 days post-discharge was not consistently different in the two systems. There are substantial differences between the DHS and KP in the rates of preventable hospitalisations and subsequent readmissions associated with chronic conditions, which suggest much opportunity for improvement within the Danish healthcare system. Reductions in hospitalisations also could improve patient welfare and free considerable resources for use towards preventing disease exacerbations. These conclusions may also apply for similar public systems such as the US Medicare system, the NHS and other systems striving to improve the integration of care for persons with chronic conditions.

• [Uncertain effects of health risk appraisals at worksites].

  Authors: Anne Rytter Hansen, Jes Søgaard

  Ugeskrift for laeger. 08/2011; 173(33):1945-8.

  Health risk appraisals take place at Danish worksites even though the effects are unknown. The purpose of this article is to summarise international studies of health risk appraisals at worksites andHealth risk appraisals take place at Danish worksites even though the effects are unknown. The purpose of this article is to summarise international studies of health risk appraisals at worksites and identify the existing knowledge on the cost-effectiveness and effects on health. The studies show tendencies of small, but positive effects of health risk appraisals in combination with counselling on certain cardiovascular risk factors. It is, however, not possible to determine the economic effects of the efforts.

• [International comparisons of health systems].

  Authors: Michaela Louise Schiøtz, Jes Søgaard, Signild Vallgårda, Allan Krasnik

  Ugeskrift for laeger. 03/2010; 172(10):771-4.

  International comparisons of health systems are widely used as a method for cross country learning, strategy development at the national level, and to demonstrate accountability. Comparisons mayInternational comparisons of health systems are widely used as a method for cross country learning, strategy development at the national level, and to demonstrate accountability. Comparisons may comprise entire health systems or subsystems within these, and may include many or few health systems. This paper describes strengths and weaknesses of different types of comparisons and methodological challenges involved in comparing different health systems. Finally, the paper emphasizes that caution must be exercised when transferring ideas from one system to another.

• [Obesity related health care costs assessed from BMI or waist circumference--secondary publication]

  Authors: Betina Højgaard, Kim Rose Olsen, Jes Søgaard, Dorte Gyrd-Hansen, Thorkild I A Sørensen

  Ugeskrift for laeger. 10/2009; 171(43):3068-71.

  Obesity is associated with increased risk of many diseases and mortality. The risk is related to body fat distribution such that abdominal obesity is associated with a greater risk thanObesity is associated with increased risk of many diseases and mortality. The risk is related to body fat distribution such that abdominal obesity is associated with a greater risk than gluteo-femoral obesity. Individual cumulative health service costs were estimated in relation to waist circumference (WC) and body mass index (BMI). The analyses show that the combination of BMI and WC does not improve the identification of high-risk individuals compared with the use of WC alone. The health service costs increase by 1.24% in women and 2.08% in men pr. cm increase in WC above the normal range.

• [Convalescence and health economics]

  Authors: Michael Nyhus, Jes Søgaard

  Ugeskrift for laeger. 09/2009; 171(40):2888-92.

  National health policies have been proposed to reduce long-term absenteeism in order to increase labour supply. Convalescence interventions have been developed and optimised and shown to reduceNational health policies have been proposed to reduce long-term absenteeism in order to increase labour supply. Convalescence interventions have been developed and optimised and shown to reduce long-term absenteeism and as such they form an integral part of the national health policy. We describe absenteeism and convalescence within an economic perspective. In Denmark, the economic costs of absenteeism amounted to more than 37 billion Danish kroner in 2006, including sick leave benefits and non-productive wage expenditure. Optimising convalescence interventions, if efficacious, is highly cost-effective.

• Economic costs of abdominal obesity.

  Authors: Betina Højgaard, Kim Rose Olsen, Jes Søgaard, Thorkild I A Sørensen, Dorte Gyrd-Hansen

  Obesity facts. 01/2008; 1(3):146-54.

  To examine the relationship between waist circumference and future health care costs across a broad range of waist circumference values based on individual level data. A prospective cohort of 31,840To examine the relationship between waist circumference and future health care costs across a broad range of waist circumference values based on individual level data. A prospective cohort of 31,840 subjects aged 50-64 years at baseline had health status, lifestyle and socio-economic aspects assessed at entry. Individual data on health care consumption and associated costs were extracted from registers for the subsequent 7 years. Participants were stratified by presence of chronic disease at entry. Increased waist circumference at baseline was associated with higher future health care costs. For increased and substantially increased waist circumference health care costs rise at a rate of 1.25% in women and 2.08% in men, per added centimetre above normal waistline. Thus, as an example, a woman with a waistline of 95 cm and without co-morbidities can be expected to incur an added future cost of approximately USD 397.- per annum compared to a woman in the normal waist circumference group, corresponding to 22% higher health care costs. Future health care costs are higher for persons who have an increased waist circumference, which suggests that there may be a potential for significant resource savings through prevention of abdominal obesity.

• Waist circumference and body mass index as predictors of health care costs.

  Authors: Betina Højgaard, Dorte Gyrd-Hansen, Kim Rose Olsen, Jes Søgaard, Thorkild I A Sørensen

  PLoS ONE. 01/2008; 3(7):e2619.

  BACKGROUND: In the present study we analyze the relationship between body mass index (BMI) and waist circumference (WC) and future health care costs. On the basis of the relation between theseBACKGROUND: In the present study we analyze the relationship between body mass index (BMI) and waist circumference (WC) and future health care costs. On the basis of the relation between these anthropometric measures and mortality, we hypothesized that for all levels of BMI increased WC implies added future health care costs (Hypothesis 1) and for given levels of WC increased BMI entails reduced future health care costs (Hypothesis 2). We furthermore assessed whether a combination of the two measures predicts health care costs better than either individual measure. RESEARCH METHODOLOGY/PRINCIPAL FINDINGS: Data were obtained from the Danish prospective cohort study Diet, Cancer and Health. The population includes 15,334 men and 16,506 women 50 to 64 years old recruited in 1996 to 1997. The relationship between future health care costs and BMI and WC in combination was analyzed by use of categorized and continuous analyses. The analysis confirms Hypothesis 1, reflecting that an increased level of abdominal fat for a given BMI gives higher health care costs. Hypothesis 2, that BMI had a protective effect for a given WC, was only confirmed in the continuous analysis and for a subgroup of women (BMI<30 kg/m(2) and WC <88 cm). The relative magnitude of the estimates supports that the regressions including WC as an explanatory factor provide the best fit to the data. CONCLUSION: The study showed that WC for given levels of BMI predicts increased health costs, whereas BMI for given WC did not predict health costs except for a lower cost in non-obese women with normal WC. Combining WC and BMI does not give a better prediction of costs than WC alone.

• Preventive health screenings and health consultations in primary care increase life expectancy without increasing costs.

  Authors: Susanne R Rasmussen, Janus L Thomsen, Jannie Kilsmark, Anne Hvenegaard, Marianne Engberg, Torsten Lauritzen, Jes Søgaard

  Scandinavian journal of public health. 02/2007; 35(4):365-72.

  AIMS: The intention was to investigate whether preventive health checks and health discussions are cost effective. METHODS: In a randomized trial the authors compared two intervention groups (A andAIMS: The intention was to investigate whether preventive health checks and health discussions are cost effective. METHODS: In a randomized trial the authors compared two intervention groups (A and B) and one control group. In 1991 2,000 30- to 49-year-old persons were invited and those who accepted were randomized. Both intervention groups were offered a broad (multiphasic) screening including cardiovascular risk and a personal letter including screening results and advice on healthy living. Individuals in group A could contact their family physician for a normal consultation whereas group B were given fixed appointments for health consultations. The follow-up period was six years. Analysis was carried out on the "intention to treat" principle. Outcome parameters were life years gained, and direct and total health costs (including productivity costs), discounted by 3% annually. Costs were based on register data. Univariate sensitivity analysis was carried out. RESULTS: Both intervention groups have significantly better life expectancy than the control group (no intervention). Group B and (A) significantly gain 0.14 (0.08) life years more than the control group. There were no differences in average direct (3,255 euro (3,703 euro) versus 4,186 euro) and total costs (10,409 euro (9,399 euro) versus 10,667 euro). The effect in group B is, however, better than in group A with no significant differences in costs. The results are insensitive to a range of assumptions regarding costs, effects, and discount rates. CONCLUSIONS: Preventive health screening and consultation in primary care in 30- to 49-year-olds produce significantly better life expectancy without extra direct and total costs over a six-year follow-up period.

• The total lifetime health cost savings of smoking cessation to society.

  Authors: Susanne R Rasmussen, Eva Prescott, Thorkild I A Sørensen, Jes Søgaard

  European journal of public health. 01/2006; 15(6):601-6.

  BACKGROUND: Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence theBACKGROUND: Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined. METHODS: The economic effects of smoking cessation in a lifetime perspective have been examined by comparing the health costs of continuing smokers and ex-smokers by quantity of daily tobacco consumption, age, gender and disease group, while taking differences in life expectancy and the reductions in relative risks after cessation into account. RESULTS: The total lifetime health cost savings of smoking cessation are highest at the younger ages. Although the economic savings vary with age at quitting, gender and quantity of daily tobacco consumption, all ex-smoking men and women who quit smoking at the age of 35 to 55 years generate sizeable total lifetime cost savings. At older ages, the total lifetime health cost savings of smoking cessation are of little economic consequence to the society. The total, direct and productivity lifetime cost savings of smoking cessation in moderate smokers who quit smoking at the age of 35 years are 24,800 euros, 7600 euros, and 17,200 euros in men, and 34,100 euros, 12,200 euros, and 21,800 euros in women, respectively. CONCLUSIONS: Lifetime health cost savings of smoking cessation to society are substantial at younger ages, in terms of both direct and productivity costs.

• [How will the treatment of patients with liver diseases become evidence-based?]

  Authors: Pia Kürstein, Jakob Kjellberg, Jes Søgaard, Christian Gluud

  Ugeskrift for laeger. 10/2005; 167(38):3610-1.

• [Waiting lists--why do they arise, and what can be done about them?]

  Authors: Jakob Kjellberg, Jes Søgaard

  Ugeskrift for laeger. 12/2004; 166(47):4237-40.

• The total lifetime costs of smoking.

  Authors: Susanne R Rasmussen, Eva Prescott, Thorkild I A Sørensen, Jes Søgaard

  European journal of public health. 04/2004; 14(1):95-100.

  BACKGROUND: Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs ofBACKGROUND: Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy. METHOD: A dynamic (life cycle) method taking differences in life expectancy into account. Main outcome measures were direct and indirect lifetime health costs for ever-smokers and never-smokers, and cost ratios (ever-smokers to never-smokers). The estimations were based on annual disease rates of use of the healthcare services, smoking relative risks, smoking prevalences, and costs. RESULTS: Annual direct and indirect costs of ever-smokers were higher than for never-smokers in all age groups of both genders. The direct and indirect cost ratios were highest at age 45 for women, and at age 35 and 40 for men, respectively. Taking life expectancy differences into account, direct and indirect lifetime health costs for men aged 35, discounted by 5% per year were 66% and 83% higher in ever-smokers than in never-smokers. Corresponding results for women were 74% and 79%, respectively. The results are insensitive to a broad range of relative risk-estimates and discount rates including no discounting. Excess costs of ever-smokers disappear if the inclusion of smoking-related diseases is narrowed to that of previous studies. CONCLUSION: Smoking imposes costs to society even when taking life expectancy into consideration--both in direct and indirect costs.