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Lindholm, L., Ivarsson, A., Löfgren, C., Meili, K., Nygren, L., Pulkki-Brännström, A.-M. & Sahlen, K.-G. (2018). Nytt sätt att mäta livskvalitet öppnar för effektivare insatser. Dagens samhälle (31), pp. 26-26
Open this publication in new window or tab >>Nytt sätt att mäta livskvalitet öppnar för effektivare insatser
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2018 (Swedish)In: Dagens samhälle, ISSN 1652-6511, no 31, p. 26-26Article in journal, News item (Other (popular science, discussion, etc.)) Published
Keywords
perspektiv, välfärd, kvalitet, forskning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-154101 (URN)
Note

Publicerad online med rubriken "Forskare: Mät välfärdens kvalitet i antal "goda år"!"

Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2019-02-27Bibliographically approved
Löfgren, C. (2014). Catastrophic health expenditure in Vietnam: studies of problems and solutions. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Catastrophic health expenditure in Vietnam: studies of problems and solutions
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In Vietnam, problems of high out-of-pocket payments for health, leading to catastrophic health expenditure and resulting impoverishment for vulnerable groups, has been at focus in the past decades. Since the beginning of the 1990’s, the Vietnamese government has launched a series of social health insurance reforms to increase prepayment in the health sector and thereby better protect the population from the financial consequences of health problems.

Objective: The objective of this thesis is to contribute to the discussion in Vietnam on how large the problems of catastrophic health expenditure are in the population as a whole and in a special subgroup; the elderly households, and to assess important aspects on health insurance as a means to reduce the problems.

Methods: Catastrophic health expenditure has been estimated, using an established and common method, from two different data sources; the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in the Bavi district, and Vietnam Household Living Standards Survey (VHLSS) 2010. Results from two cross-sectional analyses and a panel study have been compared, to gain information on whether the estimates of catastrophic health spending may be overestimated when using cross-sectional data. Then, the size of the problem for one group, the elderly households; hypothesized to be particularly vulnerable in this context, has been estimated. The question of to what extent a health insurance reform; the Health Care Funds for the Poor (HCFP), has offered protection for the insured against health spending is being assessed in another study over the period 2001 – 2007, using propensity score matching. The value that households attach to health insurance has also been explored through a willingness to pay (WTP) study.

Results: Comparing results from two cross-sectional studies with a panel study over a full year in which the respondents were interviewed once every month, the estimates of catastrophic spending vary largely. The monthly estimates in the panels study are half as large as the cross-sectional estimates; the latter also having a recall period of one month. Among the elderly households, catastrophic health spending and impoverishment are found to be problems three times as large as for the whole population. However, household health care expenditure as a percentage of total household expenditure was affected by the HCFP, and significantly reduced for the insured. In the study of household WTP for health insurance, it was iiifound that households attach a low value to this insurance form; WTP being only half of household health expenditure.

Conclusions: Cross-sectional studies of catastrophic spending with a monthly recall period are likely to be affected by recall bias leading to overestimations through respondents including expenditure in the period preceding the recall period. However, such problems should not deter researchers form studying this phenomenon. If using the same method, estimates of catastrophic spending and impoverishment can be compared between different groups – as for the elderly households – and over time; e.g. studying the protective capacity of health insurance. It should be used more, not less. The VHLSS rounds offer the Vietnamese a possibility to regularly study this. The HCFP were found to be partly protective but important problems remain to be solved, e.g. the fact that people are reluctant to use their health insurance because of e.g. quality problems and possible discrimination of the insured. The findings of a low WTP for health insurance may be another reflection of this.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. p. 121
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1673
Keywords
Catastrophic health expenditure, impoverishment, elderly, health insurance, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-93259 (URN)978-91-7601-129-4 (ISBN)
Public defence
2014-10-10, Sal B, Rosa salen, 9 tr, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2014-09-19 Created: 2014-09-15 Last updated: 2018-06-07Bibliographically approved
Sahlen, K.-G., Löfgren, C., Brodin, H., Dahlgren, L. & Lindholm, L. (2012). Measuring the value of older people's production: a diary study. BMC Health Services Research, 12, 4
Open this publication in new window or tab >>Measuring the value of older people's production: a diary study
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2012 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, p. 4-Article in journal (Refereed) Published
Abstract [en]

Background: The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study. Methods: Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data. Results: Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used. Conclusions: An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life.

Place, publisher, year, edition, pages
London: BioMed Central, 2012
Keywords
old, production, entitlement, intergenerational fairness, informal care
National Category
Health Sciences
Identifiers
urn:nbn:se:umu:diva-53947 (URN)10.1186/1472-6963-12-4 (DOI)000301444000001 ()
Available from: 2012-04-12 Created: 2012-04-10 Last updated: 2018-06-08Bibliographically approved
Lemma, H., Löfgren, C. & San Sebastian, M. (2011). Adherence to a six-dose regimen of artemether-lumefantrine among uncomplicated Plasmodium falciparum patients in the Tigray Region, Ethiopia. Malaria Journal, 10, 349
Open this publication in new window or tab >>Adherence to a six-dose regimen of artemether-lumefantrine among uncomplicated Plasmodium falciparum patients in the Tigray Region, Ethiopia
2011 (English)In: Malaria Journal, ISSN 1475-2875, E-ISSN 1475-2875, Vol. 10, p. 349-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In 2004, Ethiopia switched its first-line treatment of uncomplicated Plasmodium falciparum malaria from sulphadoxine-pyrimethamine to a fixed artemisinin-based combination therapy (ACT), artemether-lumefantrine (AL). Patient adherence to AL regimen is a major determining factor to achieve the desired therapeutic outcome. The aim of this study was to measure patient adherence levels to the six-dose AL regimen for the treatment of uncomplicated P. falciparum malaria and to identify its determinant factors in rural areas of the Tigray region, Ethiopia

METHODS: The study was conducted under routine health service delivery at health posts level. Patients/caregivers were not informed about their home visit and were traced on the day after they finished the AL regimen. By combining the response to a structured questionnaire and the tablet count from the blister, adherence level was classified into three categories: definitely non-adherent, probably non-adherent and probably adherent. Reasons for being definitely non-adherent were also assessed. For the purpose of examine risk factors, definitely non-adherent and probably non-adherent was merged into a non-adherent group. Variables found significantly associated (p < 0.05) with the adherence level on the univariate analysis were fitted into a multivariate logistic regression model.

RESULTS: Out of the total initially enrolled 180 patients, 86.1% completed the follow-up. Out of these, 38.7% were classified as probably adherent, 34.8% as probably non-adherent, and 26.5% were definitely non-adherent. The most common reasons that definitely non-adherents gave for not taking the full dose were "too many tablets" (37.3%) and to "felt better before finished the treatment course" (25.5%). The adherence of the patients was associated with the ownership of a radio (adjusted odd ratio, AOR: 3.8; 95% CI: 1.66-8.75), the belief that malaria can be treated traditionally (AOR: 0.09; 95% CI: 0.01-0.78) and a delay of more than one day in seeking treatment after the onset of fever (AOR: 5.39; 95% CI: 1.83-15.88).

CONCLUSION: The very low adherence to AL found in this study raises serious concerns for the malaria control in the region. The implementation of a monitoring adherence system is essential to ensure long-term treatment efficacy.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-51865 (URN)10.1186/1475-2875-10-349 (DOI)22141751 (PubMedID)
Available from: 2012-02-03 Created: 2012-02-03 Last updated: 2018-06-08Bibliographically approved
Lemma, H., San Sebastian, M., Löfgren, C. & Barnabas, G. (2011). Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate. Cost Effectiveness and Resource Allocation, 9, 2
Open this publication in new window or tab >>Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate
2011 (English)In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 9, p. 2-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Malaria transmission in Ethiopia is unstable and the disease is a major public health problem. Both, p.falciparum (60%) and p.vivax (40%) co-dominantly exist. The national guideline recommends three different diagnosis and treatment strategies at health post level: i) the use of a p.falciparum/vivax specific RDT as diagnosis tool and to treat with artemether-lumefantrine (AL), chloroquine (CQ) or referral if the patient was diagnosed with p.falciparum, p.vivax or no malaria, respectively (parascreen pan/pf based strategy); ii) the use of a p.falciparum specific RDT and AL for p.falciparum cases and CQ for the rest (paracheck pf based strategy); and iii) the use of AL for all cases diagnosed presumptively as malaria (presumptive based strategy). This study aimed to assess the cost-effectiveness of the recommended three diagnosis and treatment strategies in the Tigray region of Ethiopia.

METHODS: The study was conducted under a routine health service delivery following the national malaria diagnosis and treatment guideline. Every suspected malaria case, who presented to a health extension worker either at a village or health post, was included. Costing, from the provider's perspective, only included diagnosis and antimalarial drugs. Effectiveness was measured by the number of correctly treated cases (CTC) and average and incremental cost-effectiveness calculated. One-way and two-way sensitivity analyses were conducted for selected parameters.

RESULTS: In total 2,422 subjects and 35 health posts were enrolled in the study. The average cost-effectiveness ratio showed that the parascreen pan/pf based strategy was more cost-effective (US$1.69/CTC) than both the paracheck pf (US$4.66/CTC) and the presumptive (US$11.08/CTC) based strategies. The incremental cost for the parascreen pan/pf based strategy was US$0.59/CTC to manage 65% more cases. The sensitivity analysis also confirmed parascreen pan/pf based strategy as the most cost-effective.

CONCLUSION: This study showed that the parascreen pan/pf based strategy should be the preferred option to be used at health post level in rural Tigray. This finding is relevant nationwide as the entire country's malaria epidemiology is similar to the study area.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-51867 (URN)10.1186/1478-7547-9-2 (DOI)21303500 (PubMedID)
Available from: 2012-02-03 Created: 2012-02-03 Last updated: 2018-06-08Bibliographically approved
Norström, F., Ivarsson, A., Lindholm, L., Carlsson, A., Danielsson, L., Högberg, L., . . . Löfgren, C. (2011). Parents' willingness to pay for coeliac disease screening of their child. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 52(4), 452-459
Open this publication in new window or tab >>Parents' willingness to pay for coeliac disease screening of their child
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2011 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 52, no 4, p. 452-459Article in journal (Refereed) Published
Abstract [en]

Swedish parents' WTP for school-based CD screening of their child was higher than the average cost per child; however, only a minority of the parents were willing to pay that amount.

Identifiers
urn:nbn:se:umu:diva-43310 (URN)10.1097/MPG.0b013e3182037efd (DOI)21407104 (PubMedID)
Available from: 2011-04-27 Created: 2011-04-27 Last updated: 2018-06-08Bibliographically approved
Thanh, N. X., Löfgren, C., Phuc, H. D., Chuc, N. T. & Lindholm, L. (2010). An assessment of the implementation of the Health Care Funds for the Poor policy in rural Vietnam.. Health Policy, 98(1), 58-64
Open this publication in new window or tab >>An assessment of the implementation of the Health Care Funds for the Poor policy in rural Vietnam.
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2010 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 98, no 1, p. 58-64Article in journal (Refereed) Published
Abstract [en]

User fees at public health care facilities and out-of-pocket payments for health care services are major health financing problems in Vietnam. In 2002, the Government launched the Health Care Funds for the Poor (HCFP) policy which offered free public health care services to help the poor access public health services and reduce their health care expenditure (HCE). This paper is an assessment of the implementation of the HCFP in a rural district of Vietnam. The impacts of HCFP on household HCE as a percentage of total expenditure and health care utilization were assessed by a double-difference propensity score matching method using panel data of 10,711 households in 2001, 2003, 2005 and 2007. The results showed that the HCFP significantly reduced the HCE as a percentage of total expenditure and increased the use of the local public health care among the poor. However, the impacts of HCFP on the use of the higher levels of public health care and the use of go-to-pharmacies were not significant. In conclusion, this assessment indicates that the HCFP has met its objectives by reducing HCE for the poor and increasing their use of the local public health care services. However, further efforts are needed to help them access higher levels of public health care. Pharmacists should be better regulated and incorporated with primary health care to improve efficiency of the system.

Place, publisher, year, edition, pages
Elsevier, 2010
Keywords
Assessment, Health Care Funds for the Poor, Vietnam
Identifiers
urn:nbn:se:umu:diva-35322 (URN)10.1016/j.healthpol.2010.05.005 (DOI)000284556200007 ()20627438 (PubMedID)
Available from: 2010-08-12 Created: 2010-08-12 Last updated: 2018-06-08Bibliographically approved
Löfgren, C., Boman, K., Olofsson, M. & Lindholm, L. (2009). Is cardiac consultation with remote-controlled real-time echocardiography a wise use of resources?. Telemedicine journal and e-health, 15(5), 431-438
Open this publication in new window or tab >>Is cardiac consultation with remote-controlled real-time echocardiography a wise use of resources?
2009 (English)In: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 15, no 5, p. 431-438Article in journal (Refereed) Published
Abstract [en]

Northern Sweden is a sparsely populated area with six hospitals and about 50 healthcare centers. The elderly population is a large proportion of the total of population, and the incidence of cardiovascular disease is high. The objective of this research was to analyze the costs and benefits of cardiac consultation in healthcare centers involving long-distance, remote-controlled, real-time echocardiography. The distance diagnostics were developed and tested in two healthcare centers. Experiences of the feasibility of this approach were used as a basis for an economic analysis with regard to heart failure. The societal costs for two different systems were calculated, namely, traditional hospital diagnosis versus distance diagnosis using the new system. The potential prime gainers were the patients. Their traveling time, and thereby their time costs, were significantly reduced. The quality of care may also have been improved. From the health authorities' perspective, the costs of the two systems were approximately equal. Since county council costs are not greatly affected, the large reduction in patient travel time and the improved quality of care ought to be a sufficient incentive for large-scale tests.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-25318 (URN)10.1089/tmj.2008.0148 (DOI)19548823 (PubMedID)
Available from: 2009-08-12 Created: 2009-08-12 Last updated: 2018-06-08Bibliographically approved
Thuan, N. T., Löfgren, C., Chuc, N. T. & Lindholm, L. (2008). Are the estimates of catastrophic health expenditure among rural poopulation too high? A comparison of studies in Vietnam.. Open Public Health Journal, 1, 25-31
Open this publication in new window or tab >>Are the estimates of catastrophic health expenditure among rural poopulation too high? A comparison of studies in Vietnam.
2008 (English)In: Open Public Health Journal, ISSN 1874-9445, Vol. 1, p. 25-31Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the proportion of the households that experienced catastrophic health expenditure and to compare the magnitude of catastrophic health expenditure that is estimated from three different data sets in Vietnam.

Methods: The study we are comparing with is based on data from the Vietnam Living Standard Survey (VLSS) 1997/98. We have used data from the 2001 re-survey. The FilaBavi sample consists of 11,089 households. We have also conducted a special survey from July 2001 to June 2002. The sample is smaller, 629 households, but they have been followed for an entire year with monthly interviews. For VLSS and FilaBavi, re-census survey households were interviewed once with a recall period of one month.

Findings: In the VLSS data and in the FilaBavi re-census survey it was found that 9%-10% of the households experienced catastrophic healthcare spending. But, only 5% (average per month) and 1% (for the whole year) of the households in the special survey report catastrophic spending.

Conclusions: We suggest that the major reason for the difference in the estimates is the different data collection methods. When doing a cross sectional study with a relatively short recall period there is a risk that households will tend to overestimate non-recurrent large expenditures as that for health.

Place, publisher, year, edition, pages
Bentham Open, 2008
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-21843 (URN)10.2174/1874944500801010025 (DOI)
Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2018-06-08Bibliographically approved
Thuan, N. T., Löfgren, C., Lindholm, L. & Chuc, N. T. (2008). Choice of healthcare provider following reform in Vietnam. BMC Health Services Research, 8, 162
Open this publication in new window or tab >>Choice of healthcare provider following reform in Vietnam
2008 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 8, p. 162-Article in journal (Refereed) Published
Abstract [en]

Background: In Vietnam, the health-sector reforms since 1989 have lead to a rapid increase in out-of-pocket expenses. This paper examines the choice of medical provider and household healthcare expenditure for different providers in a rural district of Vietnam following healthcare reform.

Methods: The study consisted of twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample – Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002.

Results: The use of private health providers and self-treatment are quite common for both episodes (60% and 23% of all illness episodes) and expenditure (60% and 12.8% of healthcare expenditure) The poor tend to use self-treatment more frequently than wealthier members of the community (31% vs. 14.5% of illness episodes respectively). All patients in this study often use private services before public ones. The poor use less public care and less care at higher levels than the rich do (8% vs.13% of total illness episodes, which decomposes into 3% vs. 7% at district level, and 1% vs. 3% at the provincial or central level, respectively). The education of the patients significantly affects healthcare decisions. Those with higher education tend to choose healthcare providers rather than self-treatment. Women tend to use drugs or healthcare services more often than men do. Patients in two highest quintiles use health services more than in the lowest quintile. Moreover, seriously ill patients frequently use more drugs, healthcare services, public care than those with less severe illness.

Conclusion: The results are useful for policy makers and healthcare professionals to (i) formulate healthcare policies-of foremost importance are methods used to reduce self-treatment and no treatment; (ii) the management of private practices and maintaining public healthcare providers at all levels, particularly at the basic levels (district, commune) where the poor more easily can access healthcare services, is also important, as is the management of private practices and (iii) provide a background for further studies on both short and long-term health service strategies.

Place, publisher, year, edition, pages
BioMed Central, 2008
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-10455 (URN)10.1186/1472-6963-8-162 (DOI)000259216700001 ()18664300 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2008-09-12 Created: 2008-09-12 Last updated: 2018-06-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5348-7698

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