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Svensson, M. & Hultkrantz, L. (2017). A Comparison of Cost-Benefit and Cost-Effectiveness Analysis in Practice: Divergent Policy Practices in Sweden. Nordic Journal of Health Economics, 5(2), 41-53
Open this publication in new window or tab >>A Comparison of Cost-Benefit and Cost-Effectiveness Analysis in Practice: Divergent Policy Practices in Sweden
2017 (English)In: Nordic Journal of Health Economics, ISSN 1892-9729, E-ISSN 1892-9710, Vol. 5, no 2, p. 41-53Article in journal (Refereed) Published
Abstract [en]

This paper compares the implementation of the two economic evaluation methods Cost-Effectiveness/Utility (CEA/CUA) and Cost-Benefit Analysis (CBA) as tools for allocation of national public funds in the health and transport sector in Sweden, respectively. We compare the recommended values for important economic parameters such as the social discount rate, the marginal cost of public funds, and the explicit and implicit valuation of health, and document a number of substantial and unexplained differences in implementation. Such differences are problematic considering that the increasing use of economic evaluations to guide policy decisions also has implied an overlap of application areas. We conclude with a discussion on the need of a harmonized procedure for economic evaluations in the public sector in order to reduce the risk of inefficient allocations purely due to different applications of the methods.

Place, publisher, year, edition, pages
University of Oslo, 2017
Keywords
Cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, public policy
National Category
Economics
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-64433 (URN)
Available from: 2018-01-19 Created: 2018-01-19 Last updated: 2020-01-30Bibliographically approved
Dorjdagva, J., Batbaatar, E., Svensson, M., Dorjsuren, B. & Kauhanen, J. (2016). Catastrophic health expenditure and impoverishment in Mongolia. International Journal for Equity in Health, 15, Article ID 105.
Open this publication in new window or tab >>Catastrophic health expenditure and impoverishment in Mongolia
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2016 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 15, article id 105Article in journal (Refereed) Published
Abstract [en]

Background: The social health insurance coverage is relatively high in Mongolia; however, escalation of out-ofpocket payments for health care, which reached 41 % of the total health expenditure in 2011, is a policy concern. The aim of this study is to analyse the incidence of catastrophic health expenditures and to measure the rate of impoverishment from health care payments under the social health insurance scheme in Mongolia.

Methods: We used the data from the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. Catastrophic health expenditures are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national and The Wold Bank poverty lines are used.

Results: About 5.5 % of total households suffered from catastrophic health expenditures, when the threshold is 10 % of the total household expenditure. At the threshold of 40 % of capacity to pay, 1.1 % of the total household incurred catastrophic health expenditures. About 20,000 people were forced into poverty due to paying for health care.

Conclusions: Despite the high coverage of social health insurance, a significant proportion of the population incurred catastrophic health expenditures and was forced into poverty due to out-of-pocket payments for health care.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Catastrophic health expenditure, Impoverishment, Financial protection, Mongolia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-62607 (URN)10.1186/s12939-016-0395-8 (DOI)000379460500001 ()27401464 (PubMedID)2-s2.0-84979681473 (Scopus ID)
Note

Funding Agency:

UEF Doctoral School Scholarship

Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2020-01-30Bibliographically approved
Jakobsson, N. & Svensson, M. (2016). Copayments and physicians visits: A panel data study of Swedish regions 2003-2012. Health Policy, 120(9), 1095-1099
Open this publication in new window or tab >>Copayments and physicians visits: A panel data study of Swedish regions 2003-2012
2016 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 120, no 9, p. 1095-1099Article in journal (Refereed) Published
Abstract [en]

Objective: This paper analyzes how primary care physician visits are affected by the level of copayment in Sweden.

Data source: We use data between the years 2003-2012 from 21 Swedish health care regions that have the mandate to set their own level of copayment. The copayment per visit varies between 10 and 20 for these years and regions.

Study design: Our strategy to identify the causal effect and deal with unobserved endogeneity of price changes on physician visits is based on a panel data model using fixed effects to control for region and time and regional-variation in time trends.

Principal finding: We cannot reject that the copayment has no statistical or economic effect of significance, and we estimate the "zero effect" with very high precision.

Conclusion: In a setting with sub-national regions with autonomy to set copayments the results points to that the copayment is not an important predictor for the number of health care visits. The result is in line with some previous studies on European data where the range of copayments used tends to be relatively low.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Copayments, Health care, Demand, Moral hazard, Panel data
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-62608 (URN)10.1016/j.healthpol.2016.07.010 (DOI)000384864000015 ()27477892 (PubMedID)2-s2.0-84979752783 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-0573
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2020-01-30Bibliographically approved
Ryen, L. & Svensson, M. (2016). Modelling the cost-effectiveness of impact-absorbing flooring in Swedish residential care facilities. European Journal of Public Health, 26(3), 407-411
Open this publication in new window or tab >>Modelling the cost-effectiveness of impact-absorbing flooring in Swedish residential care facilities
2016 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 3, p. 407-411Article in journal (Refereed) Published
Abstract [en]

Objective: Fall-related injuries among the elderly, specifically hip fractures, cause significant morbidity and mortality as well as imposing a substantial financial cost on the health care system. Impact-absorbing flooring has been advocated as an effective method for preventing hip fractures resulting from falls. This study identifies the cost-effectiveness of impact-absorbing flooring compared to standard flooring in residential care facilities for the elderly in a Swedish setting.

Method: An incremental cost-effectiveness analysis was performed comparing impact-absorbing flooring to standard flooring using a Markov decision model. A societal perspective was adopted and incremental costs were compared to incremental gains in quality-adjusted life years (QALYs). Data on costs, probability transitions and health-related quality of life measures were retrieved from the published literature and from Swedish register data. Probabilistic sensitivity analysis was performed through a Monte Carlo simulation.

Results: The base-case analysis indicates that the impact-absorbing flooring reduces costs and increases QALYs. When allowing for uncertainty we find that 60% of the simulations indicate that impact-absorbing flooring is cost-saving compared to standard flooring and an additional 20% that it has a cost per QALY below a commonly used threshold value

Conclusions: Using a modelling approach, we find that impact-absorbing flooring is a dominant strategy at the societal level considering that it can save resources and improve health in a vulnerable population.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Oxford University Press, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-50601 (URN)10.1093/eurpub/ckv197 (DOI)000377470800013 ()26498954 (PubMedID)2-s2.0-84973359526 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Civil Contingencies Agency
Available from: 2016-06-08 Created: 2016-06-08 Last updated: 2020-01-30Bibliographically approved
Beckman, L., Svensson, M. & Frisen, A. (2016). Preference-based health-related quality of life among victims of bullying. Quality of Life Research, 25(2), 303-309
Open this publication in new window or tab >>Preference-based health-related quality of life among victims of bullying
2016 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 25, no 2, p. 303-309Article in journal (Refereed) Published
Abstract [en]

Purpose: No previous study has estimated the association between bullying and preference-based health-related quality of life (HRQoL) ("utility''), knowledge of which may be used for cost-effectiveness studies of interventions designed to prevent bullying. Therefore, the aim of the study was to estimate preference-based HRQoL among victims of bullying compared to non-victims.

Methods: A cross-sectional survey data collection among Swedish adolescents aged 15-17 years in the first year of upper secondary school was conducted in the city of Gothenburg in Sweden (N = 758). Preference-based HRQoL was estimated with the SF-6D. Regression analyses were conducted to adjust for some individual-level background variable.

Results: Mean preference-based health-related quality of life scores were 0.77 and 0.71 for non-victims and victims of bullying, respectively. The difference of 0.06 points was statistically significant (p < 0.05) and robust to inclusion of gender, age, and parental immigrant status.

Conclusions: The preference-based HRQoL estimates in this study may be used as an upper bound in economic evaluations of bullying prevention interventions, facilitating a comparison between costs and quality-adjusted lifeyears.

Place, publisher, year, edition, pages
Springer, 2016
Keywords
Bullying, Health-related quality of life, Utility scores, SF-6D
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-49444 (URN)10.1007/s11136-015-1101-9 (DOI)000370796100007 ()26271370 (PubMedID)2-s2.0-84955397636 (Scopus ID)
Available from: 2016-03-22 Created: 2016-03-22 Last updated: 2020-01-30Bibliographically approved
Jakobsson, N. & Svensson, M. (2016). The effect of copayments on primary care utilization: results from a quasi-experiment. Applied Economics, 48(39), 3752-3762
Open this publication in new window or tab >>The effect of copayments on primary care utilization: results from a quasi-experiment
2016 (English)In: Applied Economics, ISSN 0003-6846, E-ISSN 1466-4283, Vol. 48, no 39, p. 3752-3762Article in journal (Refereed) Published
Abstract [en]

This article analyses how health-care utilization is affected by copayments in a tax-financed health-care system. The article utilizes a natural experiment in which a health-care region in Sweden changed the price of healthcare in such a way that primary care general physician prices increased by 33%. We use daily visit data in the treatment region and a neighbouring control region where no price change took place and analyse the effect using differences-in-differences as well as differences-in-differences-in-differences models. The results from the preferred models indicate no effect on health-care utilization due to the price change, a result that also holds across different socio-economic subregions in the treatment region.

Place, publisher, year, edition, pages
Routledge, 2016
Keywords
Copayments, healthcare, demand, moral hazard, natural experiment
National Category
Economics and Business
Identifiers
urn:nbn:se:oru:diva-51445 (URN)10.1080/00036846.2016.1145346 (DOI)000378744900005 ()2-s2.0-84959065354 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-0573
Available from: 2016-07-28 Created: 2016-07-28 Last updated: 2020-01-30Bibliographically approved
Svensson, M. & Nilsson, F. (2016). TLV:s betalningsvilja för nya läkemedel har analyserats: Kostnadseffektivitet och sjukdomens svårighetsgrad avgörande för subvention - Cancerläkemedel får kosta mer. Läkartidningen, 113(28-30)
Open this publication in new window or tab >>TLV:s betalningsvilja för nya läkemedel har analyserats: Kostnadseffektivitet och sjukdomens svårighetsgrad avgörande för subvention - Cancerläkemedel får kosta mer
2016 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 28-30Article in journal (Refereed) Published
Abstract [en]

The Swedish Dental and Pharmaceutical Benefits Agency (TLV) is the government body responsible for deciding whether outpatient drugs are to be included in the pharmaceutical benefits scheme. This paper analyzed all decisions made by TLV between 2005 and 2011 in order to investigate how the cost-effectiveness of a drug and the severity of the disease the drug targets affected the likelihood of subsidy of a drug. We find that TLV places significant weight on both the costeffectiveness, measured as the cost per Quality-Adjusted Life Year (QALY), and disease severity. We also find that the higher cost per QALY approved for severe diseases is mainly represented by cancer drugs. Drugs targeting severe diseases other than cancer have a similar cost per QALY as for non-severe diseases.

Place, publisher, year, edition, pages
Swedish Medical Association, 2016
National Category
Economics
Identifiers
urn:nbn:se:oru:diva-62606 (URN)2-s2.0-84978886303 (Scopus ID)
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2020-01-30Bibliographically approved
Bonander, C., Jakobsson, N., Podesta, F. & Svensson, M. (2016). Universities as engines for regional growth?: Using the synthetic control method to analyze the effects of research universities. Regional Science and Urban Economics, 60, 198-207
Open this publication in new window or tab >>Universities as engines for regional growth?: Using the synthetic control method to analyze the effects of research universities
2016 (English)In: Regional Science and Urban Economics, ISSN 0166-0462, E-ISSN 1879-2308, Vol. 60, p. 198-207Article in journal (Refereed) Published
Abstract [en]

Are research universities important for regional growth and development? We study the impact on the regional economy of granting research university status to three former university colleges in three different regions in Sweden. We analyze the development in the treated regions compared to a set of control regions that are created using the synthetic control method. We find small or no effects on the regional economy. Our findings cast doubt on the effectiveness of research universities in fostering regional growth and development We contribute to the existing research by using a more credible identification strategy in assessing the effects of universities on the regional economy compared to what has usually been used in previous studies.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Higher education, Local economy, Regional development, Research, University
National Category
Economics
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-62612 (URN)10.1016/j.regsciurbeco.2016.07.008 (DOI)000385900200017 ()2-s2.0-84979306945 (Scopus ID)
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2020-01-30Bibliographically approved
Andersson, H., Hole, A. R. & Svensson, M. (2016). Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety. Journal of Environmental Economics and Management, 75, 41-53
Open this publication in new window or tab >>Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety
2016 (English)In: Journal of Environmental Economics and Management, ISSN 0095-0696, E-ISSN 1096-0449, Vol. 75, p. 41-53Article in journal (Refereed) Published
Abstract [en]

This study elicits individual risk preferences in the context of an infectious disease using choice experiments. A main objective is to examine scope sensitivity using a novel approach. Our results suggest that the value of a mortality risk reduction (VSL) is highly sensitive to the survey design. Our results cast doubt on the standard scope sensitivity tests in choice experiments, but also on the validity and reliability of VSL estimates based on stated-preference studies in general. This is important due to the large empirical literature on non-market evaluation and the elicited values' central role in policy making.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Choice experiments, Morbidity risk, Mortality risk, Scope sensitivity, Time preferences, Willingness to pay
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Business Administration
Research subject
Public health
Identifiers
urn:nbn:se:oru:diva-62613 (URN)10.1016/j.jeem.2015.11.001 (DOI)000368221400004 ()2-s2.0-84951274194 (Scopus ID)
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2020-01-30Bibliographically approved
Hultkrantz, L. & Svensson, M. (2015). Ekonomiska utvärderingar i svensk offentlig sektor - likheter och skillnader. Ekonomisk Debatt, 43(3), 40-50
Open this publication in new window or tab >>Ekonomiska utvärderingar i svensk offentlig sektor - likheter och skillnader
2015 (Swedish)In: Ekonomisk Debatt, ISSN 0345-2646, Vol. 43, no 3, p. 40-50Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Lund: Nationalekonomiska föreningen, 2015
National Category
Economics
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-46898 (URN)
Available from: 2015-12-01 Created: 2015-12-01 Last updated: 2020-01-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1113-7478

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