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Access for all? Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden.

https://arctichealth.org/en/permalink/ahliterature298271
Source
Scand J Public Health. 2019 Feb; 47(1):1-8
Publication Type
Journal Article
Date
Feb-2019
Author
Cecilia M Wagenius
Miguel San Sebastián
Per E Gustafsson
Isabel Goicolea
Author Affiliation
1 Norrbotten County Council, Public Health Centre, Sweden.
Source
Scand J Public Health. 2019 Feb; 47(1):1-8
Date
Feb-2019
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Female
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Healthcare Disparities - statistics & numerical data
Humans
Male
Patient Acceptance of Health Care - statistics & numerical data
Socioeconomic Factors
Sweden
Young Adult
Abstract
Previous studies in Sweden have detected socioeconomic inequities in access to healthcare services. However, there is limited information regarding access in younger populations. The aim of this study was to explore vertical and horizontal inequities in access to healthcare services in young adults in the north of Sweden.
The study used data from the Health on Equal Terms survey (age group 16-24 years, n = 2726) for the health and healthcare variables and from national registers for the sociodemographic characteristics. Self-rated healthcare utilization was measured as visits to general practitioners, youth clinics and nurses. Crude and multivariable binomial regression analysis, stratified by sex, was used to assess vertical equity, adjusting for sociodemographic characteristics, and horizontal equity, adjusting for need variables.
Vertical inequity was detected for all three healthcare services (youth clinics, general practitioners and nurses), with variations for men and women. Horizontal inequities were also found for both men and women in relation to all three healthcare services.
These findings suggest that both vertical and horizontal inequities in access exist for young people in northern Sweden and that the associations between sociodemographic characteristics and healthcare utilization are complex and need further investigation.
PubMed ID
29779450 View in PubMed
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An empirical note on willingness to pay and starting-point bias.

https://arctichealth.org/en/permalink/ahliterature72870
Source
Med Decis Making. 1996 Jul-Sep;16(3):242-7
Publication Type
Article
Author
N O Stålhammar
Author Affiliation
Astra Hässle AB, Mölndal, Sweden.
Source
Med Decis Making. 1996 Jul-Sep;16(3):242-7
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bias (epidemiology)
Cost-Benefit Analysis
Drug Interactions
Duodenal Ulcer - drug therapy - psychology
Esophagitis, Peptic - drug therapy - psychology
Female
Financing, Personal - statistics & numerical data
Histamine H2 Antagonists - economics
Humans
Male
Middle Aged
Patient Acceptance of Health Care - statistics & numerical data
Prescription Fees
Regression Analysis
Sweden
Abstract
One of the most serious sources of potential bias when using the contingent valuation (CV) method to assess willingness to pay (WTP) is implied-value cues, i.e., different types of starting-point bias. The possible existence of starting-point bias is serious, since it may be interpreted to mean that the responders' preferences are very unstable. While the empirical evidence from environmental economics on starting-point bias is mixed, an earlier study in health economics did not find any clear evidence of starting-point bias. However, in the study presented here, a clear presence of starting-point bias was found. In a Swedish survey of how and when patients take antisecretory drugs, the patients were asked about their willingness to pay for a medication that can be taken in relation to meals compared with one that must be taken at least one hour before meals and has the additional disadvantage that it interacts with contraceptive pills. Among the 105 respondents, 82 were willing to pay a sum in addition to the normal patient fee in order to obtain the drug that could be taken during meals. The 82 patients thereafter participated in the bidding game that could start at a low bid (SEK 20) or a high bid (SEK 1,000). On average, the patients were willing to pay an additional SEK 138 (1 SEK = 0.13 U.S. dollar, April 1995) to obtain the superior drug. However, the average WTP among the 42 patients who started at the low bid was 70 SEK, which should be compared to an average of 289 SEK among the 40 patients who initially were offered the high bid.
PubMed ID
8818122 View in PubMed
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Are people willing to pay for a community-based preventive program.

https://arctichealth.org/en/permalink/ahliterature219311
Source
Int J Technol Assess Health Care. 1994;10(2):317-24
Publication Type
Article
Date
1994
Author
L. Lindholm
M. Rosén
G. Hellsten
Author Affiliation
Karolinska Institute, Sweden.
Source
Int J Technol Assess Health Care. 1994;10(2):317-24
Date
1994
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - prevention & control
Community Health Services - economics
Costs and Cost Analysis
Humans
Patient Acceptance of Health Care - statistics & numerical data
Pilot Projects
Primary Prevention - economics
Questionnaires
Sweden
Urban health
Value of Life
Abstract
This pilot study is the first known attempt to test the willingness-to-pay or willingness-to-accept (WTP/WTA) method of assessment on a community-based primary prevention program against cardiovascular disease. The results indicate that the population's perceived WTA outweighs the program's costs by at least three to one. However, the methodological problems of using the WTP/WTA method in community-based programs are far from solved, and further research in this area is required.
PubMed ID
8034412 View in PubMed
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Characteristics of women choosing birth center care.

https://arctichealth.org/en/permalink/ahliterature64838
Source
Acta Obstet Gynecol Scand. 1993 Apr;72(3):181-8
Publication Type
Article
Date
Apr-1993
Author
U. Waldenström
C A Nilsson
Author Affiliation
Department of Obstetrics and Gynecology, Karolinska Hospital, Stockholm, Sweden.
Source
Acta Obstet Gynecol Scand. 1993 Apr;72(3):181-8
Date
Apr-1993
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
Birthing Centers - utilization
Comparative Study
Female
Humans
Maternal Age
Obstetrics
Parity
Patient Acceptance of Health Care - statistics & numerical data
Pregnancy - psychology
Prenatal care - organization & administration
Research Support, Non-U.S. Gov't
Socioeconomic Factors
Sweden
Abstract
The purpose of this study was to describe the characteristics of women choosing alternative maternity care compared with women who preferred conventional care. The former group of women had their antenatal, intrapartum and postpartum care at birth center in Stockholm, Sweden. Characteristics of the birth center care were continuity of care, restriction of medical technology, parental responsibility and self care. Altogether 1086 women enrolled for birth center care were included in the Alternative Group (AG). A sample of 630 was selected from among pregnant women who preferred conventional care (CG). Both groups filled in a structured questionnaire, and the response rate was 100% (1086) in the AG and 70% (441) in the CG. Besides having a more critical attitude to conventional procedures of maternity care, women in the AG were older, better educated and had other professions than CG women. They were in better physical health, and tended to be less anxious when thinking of the approaching birth and motherhood. They had more positive expectations of the coming birth, and a greater interest in not being separated from the newborn and the rest of the family immediately after the birth. They were also more interested in being actively involved in their own care. Generally speaking, AG women were more concerned about the psychological aspects of childbirth. No differences were found between the groups regarding civil status, proportion of native Swedes, or parity. Women whose characteristics coincide with those of the AG may be a growing proportion of the female population, due to better education and a growing concern about the disease orientation of maternity care.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
8385853 View in PubMed
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Choice of primary care provider: results from a population survey in three Swedish counties.

https://arctichealth.org/en/permalink/ahliterature133452
Source
Health Policy. 2011 Nov;103(1):31-7
Publication Type
Article
Date
Nov-2011
Author
Anna H Glenngård
Anders Anell
Anders Beckman
Author Affiliation
Institute of Economic Research, Lund University School of Economics and Management, Lund, Sweden. anna.glenngard@fek.lu.se
Source
Health Policy. 2011 Nov;103(1):31-7
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Choice Behavior
Female
Health Care Surveys
Humans
Logistic Models
Male
Middle Aged
Patient Acceptance of Health Care - statistics & numerical data
Physicians, Primary Care - statistics & numerical data
Primary Health Care - statistics & numerical data
Questionnaires
Sweden
Young Adult
Abstract
Recent reforms in Swedish primary care have involved choice of provider for the population combined with freedom of establishment and privatisation of providers. This study focus to what extent individuals feel they have exercised a choice of provider, why they exercise choice and where they search for information, based on a population survey in three Swedish counties. The design of the study enabled for studying behaviour with respect to differences in time since introduction of the reform and differences in number of alternative providers and establishments of new providers in connection with the reform. About 60% of the population in the three counties felt that they had made a choice of provider in connection with or after the introduction of a reform focusing on choice and privatisation. Establishments of new providers and having enough information increased the likelihood whereas preferences for direct access to a specialist decreased the likelihood of making a choice. The data further suggests that individuals were rather passive in their search for information and tended to choose providers that they previously had been in contact with. This is in line with results from previous studies and poses challenges for county councils governance of reforms.
PubMed ID
21703712 View in PubMed
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Dementia care and service systems - a mapping system tested in nine Swedish municipalities.

https://arctichealth.org/en/permalink/ahliterature297374
Source
BMC Health Serv Res. 2018 Oct 16; 18(1):778
Publication Type
Journal Article
Date
Oct-16-2018
Author
Connie Lethin
Lottie Giertz
Emme-Li Vingare
Ingalill Rahm Hallberg
Author Affiliation
Faculty of Medicine, Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden. connie.lethin@med.lu.se.
Source
BMC Health Serv Res. 2018 Oct 16; 18(1):778
Date
Oct-16-2018
Language
English
Publication Type
Journal Article
Keywords
Caregivers - statistics & numerical data
Cross-Sectional Studies
Dementia - diagnosis - therapy
Educational Status
Health Workforce - statistics & numerical data
Humans
Palliative Care
Patient Acceptance of Health Care - statistics & numerical data
Sweden
Abstract
In dementia care, it is crucial that the chain of care is adapted to the needs of people with dementia and their informal caregivers throughout the course of the disease. Assessing the existing dementia care system with regard to facilities, availability and utilization may provide useful information for ensuring that the professional dementia care and service system meets the needs of patients and their families from disease onset to end of life.
The aim of this study was to further develop and test a mapping system, and adapt it to a local context. In addition, the aim was to assess availability and utilization of care activities as well as professional providers' educational level in nine municipalities under the categories of Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care. This cross-sectional study was conducted in April through May 2015. Data was derived from the health care and social service systems in nine rural and urban municipalities in two counties in Sweden. The mapping system covered seven categories with altogether 56 types of health care and social service activities.
The mapping system was found to be reliable with minor adaptations to the context mainly in terms of activities. Availability of care activities was common with low utilization regarding Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care and dementia trained staff was rare. Availability and utilization of care activities and professionals' educational level was higher concerning screening, the diagnostic procedures and treatment compared with outpatient care facilities, institutional care and palliative care.
The mapping system enables policy makers and professionals to assess and develop health care and social service systems, to be offered proactively and on equal terms to people with dementia and their informal caregivers throughout the course of the disease. The educational level of professionals providing care and services may reveal where, in the chain of care, dementia-specific education for professionals, needs to be developed.
PubMed ID
30326900 View in PubMed
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Economic considerations and outcome measurement in urge incontinence.

https://arctichealth.org/en/permalink/ahliterature72652
Source
Urology. 1997 Dec;50(6A Suppl):100-7; discussion 108-10
Publication Type
Article
Date
Dec-1997
Author
G. Kobelt
Author Affiliation
Pharmacia & Upjohn, Windsor, Berkshire, United Kingdom.
Source
Urology. 1997 Dec;50(6A Suppl):100-7; discussion 108-10
Date
Dec-1997
Language
English
Publication Type
Article
Keywords
Canada
Comparative Study
Costs and Cost Analysis
Female
Humans
Incontinence Pads - economics - statistics & numerical data - utilization
Male
Middle Aged
Outcome and Process Assessment (Health Care) - economics - statistics & numerical data
Patient Acceptance of Health Care - statistics & numerical data
Quality of Life
Questionnaires
Sweden
United States
Urinary Incontinence - economics - therapy
Abstract
OBJECTIVES: Urge incontinence exacts a physical, psychological, and economic toll on affected individuals. This article examines different approaches to estimate the burden of urge incontinence on patients and discusses how costs and consequences of treatments can be evaluated and compared to other interventions. METHODS: Willingness-to-pay methodology was used in Sweden to illustrate patients' distress. Incontinence symptoms were compared to willingness-to-pay amounts and to health-related quality of life (QOL) as measured with a generic profile (SF-36) and a preference-based instrument (EuroQol). These measures were also tested using data from a clinical trial in the United States. A single effectiveness measure ("normal days") that would be meaningful to patients, physicians, and payers and could be used in cost-effectiveness analysis was tested in a multinational clinical trial. RESULTS: Willingness to pay was significantly correlated with the expected health improvement, incontinence symptoms, and income. SF-36 scores were significantly lower than for the general Swedish population and were correlated with the severity of symptoms. Utility values obtained with EuroQol were also correlated with symptoms. Similar results were obtained in the clinical trial. The composite effectiveness measure was able to discriminate between treatment and placebo, despite a high placebo effect. CONCLUSIONS: Patients with urge incontinence experience a number of different symptoms that affect activities of daily living and QOL. However, for cost-effectiveness analysis these symptoms should be expressed as a single outcome in order to allow for comparison within the same indication and to other diseases. We tested a disease-specific measure for incontinence and several generic measures to be used in cost-effectiveness analysis.
PubMed ID
9426762 View in PubMed
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Equity in health care utilization: further tests based on hurdle models and Swedish micro data.

https://arctichealth.org/en/permalink/ahliterature208529
Source
Health Econ. 1997 May-Jun;6(3):303-19
Publication Type
Article
Author
U G Gerdtham
Author Affiliation
Centre for Health Economics, Stockholm School of Economics, Sweden. heug@hhs.se
Source
Health Econ. 1997 May-Jun;6(3):303-19
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Chi-Square Distribution
Databases, Factual
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Health status
Hospitals - utilization
Humans
Likelihood Functions
Middle Aged
Models, Econometric
Models, Statistical
Office Visits - utilization
Patient Acceptance of Health Care - statistics & numerical data
Poisson Distribution
Program Evaluation
Regression Analysis
Sampling Studies
Social Class
Social Justice
Socioeconomic Factors
State Medicine - standards
Sweden
Urban health
Abstract
This paper tests the null hypothesis of no horizontal inequity in delivery of health care by use of count data hurdle models and Swedish micro data. It differs from most earlier work in three principal ways: First, the tests are carried out separately for physician and hospital care; second, the tests are carried out separately for the probability of seeking care and the amount of care received (given any use); and third, the tests are based on a model that includes several socioeconomic variables, e.g. income, education and size of community of residence. The paper rejects the hypothesis of no inequity because socioeconomic factors also have significant effects on utilization, e.g. income and size of community of residence. Size of community of residence has a positive significant effect on the frequency of physician visits but not on the probability of visiting a physician.
PubMed ID
9226147 View in PubMed
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Factors associated with switching and combination use of antidepressants in young Swedish adults.

https://arctichealth.org/en/permalink/ahliterature106737
Source
Int J Clin Pract. 2013 Dec;67(12):1302-10
Publication Type
Article
Date
Dec-2013
Author
K. Andersson Sundell
M G Petzold
S M Wallerstedt
Author Affiliation
Nordic School of Public Health, Gothenburg, Sweden; Section of Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Source
Int J Clin Pract. 2013 Dec;67(12):1302-10
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adult
Antidepressive Agents - therapeutic use
Depressive Disorder, Major - drug therapy
Drug Substitution
Drug Therapy, Combination
Educational Status
Female
Humans
Male
Patient Acceptance of Health Care - statistics & numerical data
Sex Factors
Sweden
Treatment Outcome
Young Adult
Abstract
Little is known on factors associated with switching and combination use of antidepressants. Our aim was to describe such use and to analyse the association with socioeconomic factors and level of care in Swedish adults aged 20-34 years.
Individuals, aged 20-34 years, who purchased an antidepressant in January-June 2006, and who had not purchased any antidepressant in the preceding 6 months (n = 24,897) were followed from 6 up to 12 months. Among those who purchased = 2 antidepressant substances, switchers were defined as those who did not fulfil the requirements for combination use. Data on purchased antidepressants and socioeconomic characteristics were obtained from the Swedish Prescribed Drug Register and Statistics Sweden. The association between (i) = 2 antidepressants or (ii) switching, respectively, and socioeconomic factors as well as level of care was analysed with multiple logistic regression.
A total of 4254 individuals (17%) purchased = 2 antidepressant substances, and the remaining 20,643 (83%) purchased one antidepressant. The adjusted odds ratio (OR) for purchase of = 2 antidepressants (vs. purchase of one antidepressant only) was higher among those who started on mirtazapine compared with selective serotonin re-uptake inhibitors: 2.23 (95% confidence interval: 1.93-2.57), and lower in individuals with high education: 0.64 (0.54-0.75), and shorter length of follow-up: 0.73 (0.62-0.85). Among those with = 2 antidepressants, 71.6% were classified as switchers. The adjusted OR for switching (vs. combination use) were higher among divorced/widows/widowers: 1.61 (1.05-2.49), and lower among individuals with short university education: 0.58 (0.43-0.78), those starting on mirtazapine: 0.78 (0.62-0.97), and when treatment was initiated in psychiatric care: 0.75 (0.63-0.88).
One of six new users purchased at least two antidepressants, the majority were classified as switchers. Purchase patterns were associated with socioeconomic characteristics, in particular level of education, type of first purchased antidepressant, and level of care initiating treatment.
PubMed ID
24118600 View in PubMed
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Future pandemics and vaccination: Public opinion and attitudes across three European countries.

https://arctichealth.org/en/permalink/ahliterature276566
Source
Vaccine. 2016 Feb 3;34(6):803-8
Publication Type
Article
Date
Feb-3-2016
Author
Domino Determann
Esther W de Bekker-Grob
Jeff French
Helene A Voeten
Jan Hendrik Richardus
Enny Das
Ida J Korfage
Source
Vaccine. 2016 Feb 3;34(6):803-8
Date
Feb-3-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Disease Outbreaks - prevention & control
Female
Focus Groups
Health Knowledge, Attitudes, Practice
Humans
Influenza A Virus, H1N1 Subtype
Influenza Vaccines - therapeutic use
Influenza, Human - prevention & control
Male
Middle Aged
National Health Programs
Netherlands
Patient Acceptance of Health Care - statistics & numerical data
Poland
Public Opinion
Social norms
Sweden
Trust
Vaccination - psychology
Young Adult
Abstract
Understanding public opinion and attitudes regarding vaccination is crucial for successful outbreak management and effective communication at the European level.
We explored national differences by conducting focus group discussions in The Netherlands, Poland and Sweden. Discussions were structured using concepts from behavioural models.
Thematic analysis revealed that participants would base their vaccination decision on trade-offs between perceived benefits and barriers of the vaccine also taking into account the seriousness of the new outbreak. Except for those having chronic diseases, participants expected a low infection risk, resulting in a low willingness to get vaccinated. Information about the health status of cases was considered important since this might change perceived susceptibility. Participants displayed concerns about vaccine safety due to the limited available time to produce and test vaccines in the acute situation of a new pandemic. Swedish participants mentioned their tendency of doing the right thing and following the rules, as well as to get vaccinated because of solidarity with other citizens and social influences. This appeared much less prominent for the Dutch and Polish participants. However, Swedish participants indicated that their negative experiences during the Influenza A/H1N1 2009 pandemic decreases their acceptance of future vaccinations. Polish participants lacked trust in their national (public) health system and government, and were therefore sceptical about the availability and quality of vaccines in Poland.
Although participants overall expressed similar considerations, important differences between countries stand out, such as previous vaccination experiences, the degree of adherence to social norms, and the degree of trust in health authorities.
PubMed ID
26740251 View in PubMed
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