Ismo Linnosmaa

• Professor
• Professor at University of Eastern Finland and Finnish Institute for Health and Welfare

Purpose The provision and funding of long-term care (LTC) for older people varies between European countries. Despite differences, there is limited information about the comparative performance of LTC systems in Europe. In this study, we compared quality of life (QoL) of informal carers of home care service users in Austria, England and Finland. M...

Introduction Mental health disorders are increasing worldwide, leading to significant personal, economic, and social consequences. Mental health promotion and prevention have been the subject of many systematic reviews. Thus, decision makers likely face the problem of going through literature to find and utilize the best available evidence. Therefo...

Aims To evaluate the impact of the updated nationwide Meds75+ database and its linkage to the Finnish health portal on the use of potentially inappropriate medications (PIMs) among older persons. We also aimed to evaluate whether there is regional variation in trend changes of PIM use. Methods Meds75+ was implemented at the population level in 201...

Aims: To assess the validity and completeness of the Care Register for Social Welfare among community-dwelling people with Alzheimer’s disease in Finland. Methods: The study was carried out in the Medication Use and Alzheimer’s disease (MEDALZ) study population, which includes 70,719 people who received a clinically verified diagnosis of Alzheimer’...

Background Multimorbidity is a rising global phenomenon, placing strains on countries’ population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disea...

This study developed Finnish preference weights for the seven-attribute Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer) and investigated survey fatigue and learning in best-worst scaling (BWS) experiments. An online survey that included a BWS experiment using the ASCOT-Carer was completed by a sample from the general population in Finla...

We analyzed the effectiveness of sheltered housing and the quality of life of service users with the ASCOT-INT4 service user measure. We evaluated the suitability of the measure and the associations between specific service quality indicators and the unweighted SCRQoL and effectiveness. Our findings from interview surveys (N = 101) indicated that t...

A non-trivial fraction of people cannot afford to buy pharmaceutical products at unregulated market prices. This paper analyses the public insurance of a patent-protected pharmaceutical product in terms of price controls and socially optimal third-degree price discrimination. First, the paper characterizes the Ramsey pricing rule in the case where...

Purpose The Adult Social Care Outcomes Toolkit for informal carers (ASCOT-Carer) can be used to assess long-term care-related quality of life (LTC-QoL) of adult informal carers of persons using LTC services. The ASCOT-Carer instrument has been translated into several languages, but preference weights reflecting the relative importance of different...

Introduction: The Adult Social Care Outcomes Toolkit (ASCOT) was developed in England to measure people’s social care-related quality of life (SCRQoL). Objectives: The aim of this paper is to estimate preference weights for the Finnish ASCOT for service users (ASCOT-SU). In addition, we tested for learning and fatigue effects in the choice experime...

We study the relationship between patient choices and provider quality in a rehabilitation service for disabled patients who receive the service frequently but do not have access to quality information. Previous research has found a positive relationship between patient choices and provider quality in health services that patients typically do not...

Mielenterveyssairastavuus on Pohjois-Savossa valtakunnallisesti korkealla tasolla. Päihdesairauk-sien hoitojaksoja, alkoholikuolemia ja huumausainerikoksia oli Pohjois-Savossa vuonna 2018 enemmän kuin Suomessa keskimäärin. Nuoret ja raskaana olevat naiset tupakoivat enemmän kuin vastaavat ryhmät Suomessa. Pienituloisia kotitalouksia oli enemmän ja...

European countries have developed a range of long-term care (LTC) policy responses to support the increasing share of older people. However, little is known about the effectiveness of LTC services and benefits, particularly their impact on older peoples’ quality of life (QoL). This paper investigates the role of personal, care service and environme...

Purpose The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer), developed in England, measures the effects of long-term care (LTC) services and carer support on informal carers’ quality of life (QoL). Translations of the ASCOT-Carer into other languages are useful for national and cross-national studies. The aim of this paper was to report...

The Adult Social Care Outcomes Toolkit four response-level interview schedule (ASCOT INT4) for service users was translated into Finnish. The aim of this paper was to investigate the construct validity and structural characteristics of the Finnish ASCOT. We used data from a face-to-face interview survey of older people receiving publicly funded hom...

Background: There has been considerable interest in using the Adult Social Care Outcomes Toolkit (ASCOT), developed in England, to measure quality-of-life outcomes of long-term care (LTC-QoL) service provision in national and cross-national studies. Objectives: The aim of this study was to translate and culturally adapt the original ASCOT servic...

The main descriptive findings from surveys using the Adult Social Care Outcomes Toolkit (ASCOT) Exploring Comparative Effectiveness and Efficiency in Long-term Care (EXCELC), an international research project, started in 2015 to explore the comparative effectiveness and efficiency of non-institutional long-term care in Austria, England and Finland....

Objective: To compare the costs and monetary benefits of non-pharmacological interventions for patients with Alzheimer's disease in real-world settings. Methods: A systematic review was performed to determine the most effective treatment strategies for being able to stay at home for patients with Alzheimer's disease. Care-management, family supp...

We study physiotherapy providers’ prices in repeated competitive biddings where multiple providers are accepted in geographical districts. Historically, only very few districts have rejected any providers. We show that this practice increased prices and analyze the effects the risk of rejection has on prices. Our data are derived from three subsequ...

The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) was developed in England to obtain information about caregivers’ social care-related quality of life (SCRQoL). The instrument was translated into Finnish in 2015–2016. The aim of this paper is to develop preference weights for SCRQoL using the Finnish ASCOT-Carer.

Background: The Adult Social Care Outcomes Toolkit (ASCOT) measures quality-of-life (QoL) outcomes of long-term care (LTC) service provision. Country-specific preference weights are required to calculate ASCOT scores. ASCOT has been translated into German, but lacks preference weights for German-speaking countries. Objectives: This paper aims to...

Background: There is increasing interest in assessing the effects of interventions on older people, people with long-term conditions and their informal carers for use in economic evaluation. The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) is a measure that specifically assesses the impact of social care services on informal carers....

Objectives: Barriers on healthcare access can cause a welfare loss to patients in need of care. The value of the loss depends on the severity of the illness and its effect on the patients’ wellbeing and ability to work. Previous empirical studies have examined the access to healthcare from the organizational viewpoint, focusing for example on the n...

Purpose Traditionally, researchers have relied on eliciting preferences through face-to-face interviews. Recently, there has been a shift towards using internet-based methods. Different methods of data collection may be a source of variation in the results. In this study, we compare the preferences for the Adult Social Care Outcomes Toolkit (ASCOT)...

We test the physicians’ altruism and moral hazard hypotheses using a national panel register containing all 2003–2010 statins prescriptions in Finland. We estimate the likelihood that physicians prescribe generic versus branded versions of statins as a function of the shares of the difference between what patients have to pay out of their pocket an...

We assess how different outcomes of social care indicated by the Adult Social Care Outcome Toolkit (ASCOT) measure are valued in Finland. We will examine taste heterogeneity, i.e. whether variation in different outcomes of social care can be explained by characteristics of different population groups. These working steps are essential before going...

In health care, many aspects of the delivery of services are subject to regulation. Often the purpose of the regulated health care system is to encourage providers to keep costs down without skimping on quality. The purpose of this paper is to analyse the effect of price regulation and free choice on quality in physiotherapy organised by the Social...

We explore self-assessed QoL in Austria, England and Finland. We utilize data from the research project comparing the social care related QoL in Austria, England and Finland. We will focus on the overall QoL of individuals, leaving outside psychological, social or care aspects. In addition to the comparative analysis of QoL between the three countr...

Our study focuses on competition and quality in physiotherapy organized and regulated by the Social Insurance Institution of Finland (Kela). We first derive a hypothesis with a theoretical model and then perform empirical analyses of the data. Within the physiotherapy market, prices are regulated by Kela, and after registration eligible firms are a...

We estimate the effect of competition on quality and prices in physiotherapy organised and financed by the Social Insurance Institution of Finland for disabled individuals. Within the physiotherapy market, firms participate in competitive bidding, prices are determined by the market, services are free at the point of use and firms are allowed to re...

Objectives: The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. Methods: A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finl...

Background Memory disorders are already the most important group of diseases which affect functional capacity and independence and increase the need for services amongst elderly people in Finland. As our population will be rapidly growing older within the next decades, it is of utmost importance for the survival of our welfare society to be able to...

We have constructed a formal model on cost-benefit of new technology in health care, and apply it on boron neutron capture therapy (BNCT). We assume that the patient health benefit from getting cured in acute treatment is always higher than the patient utility resulting from any long term treatment or death. This assumption makes it possible to eva...

There are numerous streams of literature within health economics that have dealt with provider altruism from different angles and perspectives. These different streams, however, have somehow proceeded in parallel, and have rarely been interlinked and systematically tied together. In particular, what is currently missing is a critical overview bridg...

In this paper we study the effects of generic substitution policy on brand-name (originator) and generic drug prices. Generic substitution policy was applied in 2003 in Finland. The Finnish framework provides a setting where only generic substitution was applied. Our theoretical model yields two different predictions for policy outcomes. According...

Aim and Motivation: This paper investigates the income and socio-economic effects on institutional long-term care demand (LTC) in Finland from an economics perspective. If lessons are learned from major contributors of care needs and costs then preventative measures can be designed to answer these challenges. The motivation for this paper is that L...

Many health care reforms rely on competition although health care differs in many respects from the assumptions of perfect competition. Finnish occupational health services provide an opportunity to study empirically competition, ownership and payment systems and the performance of providers. In these markets employers (purchasers) choose the provi...

As reforms in publicly funded health systems rely heavily on competition, it is important to know if and how public providers react to competition. In many European countries, it is empirically difficult to study public providers in different markets, but in Finnish occupational health services, both public and private for-profit and non-profit pro...

Terveyspalvelut 2010; 1 (3): 62–65.

Cost-effectiveness analyses facilitate the allocation of health care resources. The aim of the study was to compare the cost-effectiveness of group treatment, already known to be more effective, with routine counseling in obese children. A prospective 6-month intervention assessed family-based group treatment (15 separate sessions for parents and c...

This article studies the pricing and advertising of prescription drugs in a duopoly market. If advertising is banned, decisions of the prescribing physician are price-sensitive. The emerging market equilibrium is characterized by marginal-cost pricing and normal profits. The introduction of advertising, and physician-oriented advertising (detailing...

The aim of this article is to provide information on how different price-regulation environments affect the price-cost margins of the pharmaceutical industry. To this end, we estimate the US pharmaceutical industry's price markups, or price-cost margins, against Finland's highly regulated governmental price-setting system. Theoretically, the estima...

New technological applications are usually expected to increase the health care costs. But they can also spawn cost savings in the long run, for example, when making time-consuming diagnostic methods more efficient and facilitating targeted therapy. This study analyses how the implementation of new technological applications in acute treatment affe...

High prices of new pharmaceuticals play an important part in rapidly rising pharmaceutical costs. Many countries try to curb these rising costs through control of the price of reimbursable medicines. There is, however, little internationally comparable information on prices. This study aimed to examine the prices of new, reimbursable pharmaceutical...

This contribution estimates the price-cost margin in the Finnish pharmaceutical industry. The estimation is based on the method developed by Hall who shows that under constant returns to scale total factor productivity growth depends on the growth of output-capital ratio if the market is imperfectly competitive. Measurement of the price-cost margin...

Gastroesophageal reflux disease (GERD), is a common disorder. The most effective medical treatment for GERD is a proton pump inhibitor (PPI). The aim of this study was to specify the most inexpensive PPI therapy for GERD, and to examine the implications of varying outcome measure, holding time, on the conclusions about the cost-effectiveness of the...

Background: Parallel importation of pharmaceuticals is illegal in many countries. In the European Union it is allowed, as it is consistent with the principles of free trade and the community exhaustion of intellectual property rights. Parallel importation is assumed to affect pharmaceutical expenditures in two ways. First, parallel imported pharmac...

The aim of this paper is to compare the price-cost margins in the pharmaceutical industry in Finland and USA. We employ data on the Finnish and the US pharmaceutical industry. The estimation is theoretically based on a modification of the conventional growth models and its extensions under imperfectly competitive markets. The results show that the...

The purpose of this chapter is to review dental economics in three major areas: (i) demand for and utilisation of dental care, (ii) productivity, technical efficiency and economies of scale in dental care production, and finally (iii) economic evaluation of dental care procedures and programmes. As a background to the review, we consider what makes...

Farmasian Päivät 2005. Helsinki 18.–20.11.2005. Posteri ja abstrakti.

Paper presented at the 20th Meeting of the Nordic Health Economists' Study Group, Reykjavik, August 20-21, 1999.

Thesis (doctoral)--State University of New York at Stony Brook, 2001.

Hoivapalvelut 2010; 2 (4): 11–14.