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  1. AU="Kjellsson, Gustav"
  2. AU="Foerster, Bernd Uwe"
  3. AU="Wu, Hongzhuo"
  4. AU="Fleischer, Robert"
  5. AU="Di Carlo, S"
  6. AU="Rodrigue-Gervais, Ian Gaël"
  7. AU="Shayeganfar, Farzaneh"
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  1. Article ; Online: Extending decomposition analysis to account for unobserved heterogeneity and persistence in health behavior: Income-related smoking inequality among Swedish women.

    Kjellsson, Gustav

    Health economics

    2017  Volume 27, Issue 2, Page(s) 440–447

    Abstract: This article suggests an enrichment of the standard method for decomposition of the concentration index to account for unobserved heterogeneity and persistence in health behavior. As the underlying regression model in the decomposition, this approach ... ...

    Abstract This article suggests an enrichment of the standard method for decomposition of the concentration index to account for unobserved heterogeneity and persistence in health behavior. As the underlying regression model in the decomposition, this approach uses a dynamic random-effect probit that both consider individual heterogeneity, using a Mundlak type of specification, and applies a simple solution to account for smoking persistence. I illustrate the suggested approach using a panel of Swedish women in Statistics Sweden's Survey of Living Conditions for one vital health-related behavior, smoking. The results highlight the importance of persistence and show that education and living in a single household are the main drivers of income-related smoking inequality.
    MeSH term(s) Adult ; Age Factors ; Aged ; Cross-Sectional Studies ; Female ; Health Behavior ; Health Surveys ; Humans ; Income ; Middle Aged ; Models, Statistical ; Socioeconomic Factors ; Surveys and Questionnaires ; Sweden ; Tobacco Smoking
    Language English
    Publishing date 2017-07-10
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1135838-5
    ISSN 1099-1050 ; 1057-9230
    ISSN (online) 1099-1050
    ISSN 1057-9230
    DOI 10.1002/hec.3555
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  2. Article ; Online: Nätvårdsanvändare i Skåne kontaktade oftare vårdcentral - Användare av digitala vårdtjänster kontaktade fysiska vårdcentraler oftare än andra och gjorde inte färre akutbesök.

    Ellegård, Lina Maria / Kjellsson, Gustav

    Lakartidningen

    2019  Volume 116

    Abstract: Since 2016, a number of companies offering primary care services via chats or video calls have entered the Swedish primary care market. This is the first study to investigate whether these services replace other primary care services or if they induce ... ...

    Title translation Telemedicine services associated with higher use of regular primary care in a Swedish region.
    Abstract Since 2016, a number of companies offering primary care services via chats or video calls have entered the Swedish primary care market. This is the first study to investigate whether these services replace other primary care services or if they induce more care and potentially even increase the workload of traditional caregivers. Using administrative care register data from a Swedish region, we find that the use of telemedicine services is associated with higher use of other primary care services (visits and telephone/mail contacts). Further, telemedicine users visit the emergency room at least as often as other residents. We obtain similar results when using various strategies to account for differences between telemedicine users and non-users. However, we cannot completely rule out that an association between transitory health problems and telemedicine use explains the results.
    MeSH term(s) Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Community Health Centers/statistics & numerical data ; Emergency Medical Services/statistics & numerical data ; Ethnic Groups ; Facilities and Services Utilization ; Female ; Humans ; Income ; Infant ; Male ; Middle Aged ; Office Visits/statistics & numerical data ; Primary Health Care/statistics & numerical data ; Sweden ; Telemedicine/statistics & numerical data ; Young Adult
    Language Swedish
    Publishing date 2019-10-18
    Publishing country Sweden
    Document type Journal Article
    ZDB-ID 391010-6
    ISSN 1652-7518 ; 0023-7205
    ISSN (online) 1652-7518
    ISSN 0023-7205
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  3. Article ; Online: Patient choice, entry, and the quality of primary care: Evidence from Swedish reforms.

    Dietrichson, Jens / Ellegård, Lina Maria / Kjellsson, Gustav

    Health economics

    2020  Volume 29, Issue 6, Page(s) 716–730

    Abstract: Policies aiming to spur quality competition among health care providers are ubiquitous, but their impact on quality is ex ante ambiguous, and credible empirical evidence is lacking in many contexts. This study contributes to the sparse literature on ... ...

    Abstract Policies aiming to spur quality competition among health care providers are ubiquitous, but their impact on quality is ex ante ambiguous, and credible empirical evidence is lacking in many contexts. This study contributes to the sparse literature on competition and primary care quality by examining recent competition enhancing reforms in Sweden. The reforms aimed to stimulate patient choice and entry of private providers across the country but affected markets differently depending on the initial market structure. We exploit the heterogeneous impact of the reforms in a difference-in-differences strategy, contrasting more and less exposed markets over the period 2005-2013. Although the reforms led to substantially more entry of new providers in more exposed markets, the effects on primary care quality were modest: We find small improvements of patients' overall satisfaction with care, but no consistently significant effects on avoidable hospitalisation rates or satisfaction with access to care. We find no evidence of economically meaningful quality reductions on any outcome measure.
    MeSH term(s) Economic Competition ; Health Care Reform ; Humans ; Patient Preference ; Primary Health Care ; Quality of Health Care ; Sweden
    Language English
    Publishing date 2020-03-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 1135838-5
    ISSN 1099-1050 ; 1057-9230
    ISSN (online) 1099-1050
    ISSN 1057-9230
    DOI 10.1002/hec.4015
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  4. Book ; Online: Extending decomposition analysis to account for socioeconomic background

    Kjellsson, Gustav

    income-related smoking inequality among Swedish Women

    (Working paper / Department of Economics, Lund University ; 2014,29)

    2014  

    Author's details Gustav Kjellsson
    Series title Working paper / Department of Economics, Lund University ; 2014,29
    Keywords Rauchen ; Frauen ; Gesundheit ; Soziale Ungleichheit ; Konzentrationsrate ; Dekompositionsverfahren ; Schweden
    Language English
    Size Online-Ressource (65 S.)
    Publisher Dep. of Economics, Lund University
    Publishing place Lund
    Document type Book ; Online
    Database ECONomics Information System

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  5. Book ; Article ; Online: Extending Decomposition Analysis to Account for Socioeconomic Background

    Kjellsson, Gustav

    Income-Related Smoking Inequality among Swedish Women

    2014  

    Abstract: This article suggests an extension of the standard decomposition of the concentration index that allows for an exploration of the pathways through which socioeconomic background relates to income-related health inequality. This novel approach is ... ...

    Abstract This article suggests an extension of the standard decomposition of the concentration index that allows for an exploration of the pathways through which socioeconomic background relates to income-related health inequality. This novel approach is contrasted to the standard one using a panel of Swedish women in Statistics Sweden's Survey of Living Conditions for one vital health-related behavior, smoking. The decomposition uses an underlying model that considers both individual heterogeneity and smoking persistence, showing that the largest contributions to the pro-rich smoking inequality come from years of schooling and living in a single household. The contribution from socioeconomic background is close to negligible when using the standard approach. Once applying the suggested extension, socioeconomic background contributes indirectly to the inequality, primarily through an increase in years of schooling. These results highlight the potential importance of using this extension, especially for distinguishing between circumstances that individuals may affect themselves and these that are out of their control, which may be important for policy design.
    Keywords ddc:330 ; I12 ; I14 ; Health inequality ; concentration index ; decomposition ; smoking ; socioeconomic background
    Subject code 338
    Language English
    Publisher Lund: Lund University, School of Economics and Management, Department of Economics
    Publishing country de
    Document type Book ; Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Graphical Tools for Monitoring Inequality: The Beauty Can Lie (in the Details).

    Kjellsson, Gustav / Petrie, Dennis

    Epidemiology (Cambridge, Mass.)

    2017  Volume 28, Issue 4, Page(s) 604–607

    Language English
    Publishing date 2017-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1053263-8
    ISSN 1531-5487 ; 1044-3983
    ISSN (online) 1531-5487
    ISSN 1044-3983
    DOI 10.1097/EDE.0000000000000672
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3121: Show issues Location:
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  7. Book ; Online: Measuring income-related inequalities in risky health prospects

    Kjellsson, Gustav / Petrie, Dennis / Van Ourti, Tom

    (Tinbergen Institute discussion paper : V ; TI 2018, 007)

    2018  

    Abstract: The measurement of health disparities is a key component for the assessment of health systems. One aspect of these disparities - which hitherto has received limited attention - is the risk people face about their future health. This paper integrates risk ...

    Author's details Gustav Kjellsson, Dennis Petrie, Tom (T.G.M.) van Ourti
    Series title Tinbergen Institute discussion paper : V ; TI 2018, 007
    Abstract The measurement of health disparities is a key component for the assessment of health systems. One aspect of these disparities - which hitherto has received limited attention - is the risk people face about their future health. This paper integrates risk into the standard inequality measurement which measures the extent to which disparities in realized health are systematically associated with income. It develops a rank dependent inequality index that considers not only inequalities in expected future health but also the dispersion of individuals' future health prospects. It is useful when a social planner wants to account for risk averse preferences in the assessment of income-related health inequalities. The empirical application using Australian longitudinal data highlights that neglecting risk underestimates income-related health inequalities since the poor were not only expected to be in worse health in the future, but also faced greater dispersion in their future health prospects compared to the rich.
    Keywords health inequality ; risk ; concentration index
    Language English
    Size 1 Online-Ressource (circa 32 Seiten), Illustrationen
    Publisher Tinbergen Institute
    Publishing place Amsterdam, The Netherlands
    Document type Book ; Online
    Database ECONomics Information System

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  8. Article ; Online: Erratum to "A general method for decomposing the causes of socioeconomic inequality in health" [J. Health Econ. 48 (2016) 89-106].

    Heckley, Gawain / Gerdtham, Ulf-G / Kjellsson, Gustav

    Journal of health economics

    2018  Volume 61, Page(s) 274

    Language English
    Publishing date 2018-06-15
    Publishing country Netherlands
    Document type Published Erratum
    ZDB-ID 625797-5
    ISSN 1879-1646 ; 0167-6296
    ISSN (online) 1879-1646
    ISSN 0167-6296
    DOI 10.1016/j.jhealeco.2018.05.005
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    Zs.A 1779: Show issues Location:
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  9. Article ; Online: Socioeconomic distribution of GP visits following patient choice reform and differences in reimbursement models: Evidence from Sweden.

    Sveréus, Sofia / Kjellsson, Gustav / Rehnberg, Clas

    Health policy (Amsterdam, Netherlands)

    2018  Volume 122, Issue 9, Page(s) 949–956

    Abstract: Objective: This study aims to analyse changes in the socioeconomic distribution of GP visits following primary care patient choice reform, and to compare their magnitude and direction in pure capitation, versus capitation/activity-based mixed, provider ... ...

    Abstract Objective: This study aims to analyse changes in the socioeconomic distribution of GP visits following primary care patient choice reform, and to compare their magnitude and direction in pure capitation, versus capitation/activity-based mixed, provider reimbursement settings.
    Methods: We compute absolute and relative concentration indices using total population registry data from three Swedish counties (N∼3.6 million) two years pre, to two years post, reform. We decompose the indices by the contribution of first, non-recurrent and recurrent visits, and compare their changes in the different provider reimbursement settings.
    Results: In all three counties, the number of visits increased for all population groups. Increases were larger, and distributional changes more pro-poor, in the county with mixed reimbursement. Visit increases were mostly driven by recurrent and, especially, non-recurrent, visits, which were increasingly pro-poor in all counties in absolute, but not in relative, terms. First visits either became decreasingly pro-poor, or did not change significantly. Exclusion of high users removed the pro-poor patterns in the two counties with pure capitation.
    Conclusions: The reform led to increased access to GP visits, but implied small changes in their socioeconomic distribution. In combination with provider reimbursement models with incentives for higher visit volumes, changes were more pro-poor over time, but it is not clear whether this was at the expense of reduced visit length or content.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Choice Behavior ; Chronic Disease ; Female ; General Practice/statistics & numerical data ; Health Care Reform ; Health Policy ; Humans ; Male ; Middle Aged ; Reimbursement Mechanisms/organization & administration ; Socioeconomic Factors ; Sweden
    Language English
    Publishing date 2018-08-01
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 605805-x
    ISSN 1872-6054 ; 0168-8510
    ISSN (online) 1872-6054
    ISSN 0168-8510
    DOI 10.1016/j.healthpol.2018.07.017
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  10. Article ; Online: Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic.

    Milos Nymberg, Veronica / Ellegård, Lina Maria / Kjellsson, Gustav / Wolff, Moa / Borgström Bolmsjö, Beata / Wallman, Thorne / Calling, Susanna

    JMIR human factors

    2022  Volume 9, Issue 1, Page(s) e33034

    Abstract: Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been ... ...

    Abstract Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones.
    Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider.
    Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020.
    Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased.
    Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted.
    Language English
    Publishing date 2022-02-02
    Publishing country Canada
    Document type Journal Article
    ISSN 2292-9495
    ISSN (online) 2292-9495
    DOI 10.2196/33034
    Database MEDical Literature Analysis and Retrieval System OnLINE

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