Clas Rehnberg - Academia.edu (original) (raw)

Papers by Clas Rehnberg

Journal of Productivity Analysis, 2015

Previous studies indicate that Finnish hospitals have significantly higher productivity than in t... more Previous studies indicate that Finnish hospitals have significantly higher productivity than in the other Nordic countries. Since there is no natural pairing of observations between countries we estimate productivity levels rather than a Malmquist index of productivity differences, using a pooled set of all observations as reference. We decompose the productivity levels into technical efficiency, scale efficiency and country specific possibility sets (technical frontiers). Data have been collected on operating costs and patient discharges in each diagnosis related group for all hospitals in the four major Nordic countries, Denmark, Finland, Norway and Sweden. We find that there are small differences in scale and technical efficiency between countries, but large differences in production possibilities (frontier position). The countryspecific Finnish frontier is the main source of the Finnish productivity advantage. There is no statistically significant association between efficiency and status as a university or capital city hospital. The results are robust to the choice of bootstrapped data envelopment analysis or stochastic frontier analysis as frontier estimation methodology.

Additional file 1: Supplementary Figure 1. Flowchart, six-years follow-up.

Survey questionnaires and interview guides. The supplementary file consists two appendixes. APPEN... more Survey questionnaires and interview guides. The supplementary file consists two appendixes. APPENDINX-A consists quantitative questionnaire for validation study and community survey. APPENDIX-B qualitative interview guides for Key-informant Interviews SSK service providers, insurance scheme management and Health Economics Unit personnel. (PDF 195 kb)

Supplemental material, SJP863523_Supplemental_material for A performance comparison of patient pa... more Supplemental material, SJP863523_Supplemental_material for A performance comparison of patient pathways in Nordic capital areas – a pilot study for ischaemic stroke patients by Unto Häkkinen, Fanny Goude, Terje P. Hagen, Marie Kruse, Tron Moger, Mikko Peltola and Clas Rehnberg in Scandinavian Journal of Public Health

Background and aim: The incidence of mental ill health in Sweden has increased over the past few ... more Background and aim: The incidence of mental ill health in Sweden has increased over the past few years. Thus, the aim of this study is to estimate the burden of psychiatric disorders for both the direct and indirect costs in Sweden for 2001 by making comparisons with data from 1998. Method: The cost-of-illness approach, which is based on human-capital theory, was applied. We have chosen a prevalence approach and a top-down method based on aggregate healthcare expenditures from national databases. Results: The total annual economic burden of psychiatric disorders in Sweden is estimated to be €9.4 billion (€1 = SEK9.1). The direct costs are estimated to be €1.9 billion comprising 20 % of the total costs. The indirect costs are estimated to be €7.5 billion and account for the remaining 80%. A comparison with previous studies indicates that the indirect costs were 60 % and 53 % in 1975 and 1991, respectively. Conclusion: The number of beds in specialized psychiatric care decreased by 11...

BMC Family Practice, 2021

Background In recent years, telemedicine consultations have evolved as a new form of providing pr... more Background In recent years, telemedicine consultations have evolved as a new form of providing primary healthcare. Telemedicine options can provide benefits to patients in terms of access, reduced travel time and no risk of disease spreading. However, concerns have been raised that access is not equally distributed in the population, which could lead to increased inequality in health. The aim of this paper is to explore the determinants for use of direct-to-consumer (DTC) telemedicine consultations in a setting where telemedicine is included in the publicly funded healthcare system. Methods To investigate factors associated with the use of DTC telemedicine, a database was constructed by linking national and regional registries covering the entire population of Stockholm, Sweden (N = 2.3 million). Logistic regressions were applied to explore the determinants for utilization in 2018. As comparators, face-to-face physician consultations in primary healthcare were included in the study,...

BMC Emergency Medicine, 2020

Background A decision system in the ambulance allowing alternative pathways to alternate healthca... more Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of health...

BMJ Open, 2020

ObjectiveWe estimated the effect of an employer-sponsored health insurance (ESHI) scheme on healt... more ObjectiveWe estimated the effect of an employer-sponsored health insurance (ESHI) scheme on healthcare utilisation of medically trained providers and reduction of out-of-pocket (OOP) expenditure among ready-made garment (RMG) workers.DesignWe used a case–control study design with cross-sectional preintervention and postintervention surveys.SettingsThe study was conducted among workers of seven purposively selected RMG factories in Shafipur, Gazipur in Bangladesh.ParticipantsIn total, 1924 RMG workers (480 from the insured and 482 from the uninsured, in each period) were surveyed from insured and uninsured RMG factories, respectively, in the preintervention (October 2013) and postintervention (April 2015) period.InterventionsWe tested the effect of a pilot ESHI scheme which was implemented for 1 year.Outcome measuresThe outcome measures were utilisation of medically trained providers and reduction of OOP expenditure among RMG workers. We estimated difference-in-difference (DiD) and a...

Research in Social and Administrative Pharmacy, 2016

Background: Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is ... more Background: Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. Objective: To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out‐of‐pocket costs and lost productivity caused by ADEs according to socio‐economic characteristics. Method: In a random sample of 5025 adults in a Swedish county, prevalence‐based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio‐economic characteristics. Results: Costs for resource use caused by ADEs were &U20AC;505 per patient with ADEs (95% confidence interval &U20AC;345–665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were &U20AC;1631, of which &U20AC;410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (&U20AC;426 vs. &U20AC;109, p = 0.018). Out‐of‐pocket costs displaced a larger proportion of the disposable income among low‐income earners than higher income earners (0.7% vs. 0.2%–0.3%). Conclusion: We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. HighlightsIndirect costs contributed to the overall costs for adverse drug events, even when limited to time spent in healthcare.Adverse drug events and their consequences are a burden throughout the society and not limited to local health authorities.We found inequalities in the distribution of costs caused by adverse drug events in Sweden, by sex and by income.

BMJ Open

ObjectiveTo evaluate the effects of competition and a bundled payment model on the performance of... more ObjectiveTo evaluate the effects of competition and a bundled payment model on the performance of hip replacement surgery.DesignA quasi-experimental study where a difference-in-differences analytical framework is applied to analyse routinely collected patient-level data from multiple registers.SettingHospitals providing hip replacement surgery in Sweden.ParticipantsThe study included patients who underwent elective primary total hip replacement due to osteoarthritis from 2005 to 2012. The final study sample consisted of 85 275 hip replacement surgeries, where the exposure group consisted of 14 570 surgeries (n=6380 prereform and n=8190 postreform) and the control group consisted of 70 705 surgeries (n=32 799 prereform and n=37 906 postreform).InterventionA reform involving patient choice, free entry of new providers and a bundled payment model for hip replacement surgery, which came into force in 2009 in Region Stockholm, Sweden.Outcome measuresPerformance is measured as length of s...

Additional file 4: Supplementary Table 3. Results from the sensitivity analyses.

Additional file 3: Supplementary Table 2. Results from the unweighted DiD analyses

Health Policy, 2013

This article describes the methodological challenges associated with disease-based international ... more This article describes the methodological challenges associated with disease-based international comparison of health system performance and how they have been addressed in the EuroHOPE (European Health Care Outcomes, Performance and Efficiency) project. The project uses linkable patient-level data available from national sources of Finland, Hungary, Italy, The Netherlands, Norway, Scotland and Sweden. The data allow measuring the outcome and the use of resources in uniformly-defined patient groups using standardized risk adjustment procedures in the participating countries. The project concentrates on five important disease groups: acute myocardial infarction (AMI), ischemic stroke, hip fracture, breast cancer and very low birth weight and preterm infants (VLBWI). The essentials of data gathering, the definition of the episode of care, the developed indicators concerning baseline statistics, treatment process, cost and outcomes are described. The preliminary results indicate that the disease-based approach is attractive for international performance analyses, because it produces various measures not only at country level but also at regional and hospital level across countries. The possibility of linking hospital discharge register to other databases and the availability of comprehensive register data will determine whether the approach can be expanded to other diseases and countries.

European Journal of Public Health, 2017

Health Policy, 2021

OBJECTIVE One of the more important objectives with the patient choice reform, introducing non-pr... more OBJECTIVE One of the more important objectives with the patient choice reform, introducing non-price competition in Swedish primary healthcare, was to improve performance and quality of care. However, in order for choice to lead to quality improvements, citizens need to consider quality aspects in their choices of provider. We hypothesize that quality of care influences choice of provider and the objective of this study is to investigate if citizens are willing to make a trade-off between distance to chosen provider and quality of care. METHODS We use conditional logit models to analyse if quality and other provider attributes influence choice of provider. The study population includes all citizens of Region Stockholm with at least one primary healthcare contact (N ~1.4 million). RESULTS The results show that distance is the most important factor in choosing a primary healthcare provider but that there seems to be a willingness to make a trade-off between distance and quality measures. However, other provider attributes, such as the Care Need Index of the registered population, seem to influence choice to a greater extent than quality. CONCLUSION The results point in the same direction as the arguments behind the patient choice reform. However, the effects are marginal. To enhance quality competition, policy makers should consider making quality information at the provider level more accessible.

Water Policy, 2005

The burden of water-related disease is closely related to both the socio-economic situation and p... more The burden of water-related disease is closely related to both the socio-economic situation and public health issues like access to clean water, sanitation and hygiene services. Poverty eradication, through improved access to water and sanitation, is the South African government's major priority. This is partly achieved through subsidising the cost of water and sanitation provision to the poor in rural areas. Whilst the new policies have made a remarkable impact on improved access to water and sanitation services, a general problem since the new approach in 1994 has been the lack of integration of policies for water and sanitation and health. This paper analyses the policies concerning rural water supply and sanitation in South Africa. It considers the structure of institutions, the division of responsibilities and legislated and financial capacity of the South Africa's water sector. A more integrated approach for the policies aiming at water access, sanitation and health is...