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  • 1.
    Akhavan, Sharareh
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Blev det ett genombrott?: Utvärdering av det nationella lärandeprojektet – Vård på lika villkor2014Report (Other academic)
    Abstract [sv]

    Sjukvården i Sverige är i dag inte jämlik, har brister i tillgänglighet och erbjuds inte på likvärdiga villkor trots Hälso- och sjukvårdslagens mål om en god hälsa och en vård på lika villkor för hela befolkningen.

    För att bryta den pågående trenden och öka jämlikheten gjordes en överenskommelse mellan regeringen och SKL om lärandeprojektet Vård på lika villkor (under åren 2011–2014). Syftet med projektets har varit att inom socioekonomiskt resurssvaga bostadsområden öka jämlikheten i första linjens vård. Detta genom att testa, utveckla och identifiera effektiva arbetssätt och metoder vid sju primärvårdsverksamheter från fem landsting i Sverige.

    Mälardalens högskola, Akademin för hälsa, vård och välfärd, fick av SKL i uppdrag att svara för forskarstöd och att genomföra en utvärdering av de metoder och arbetssätt som utvecklades och testades i lärandeprojektet.

    Resultatet från den genomförda utvärderingen som belyser den genomförda processen, mål- och resultat samt hälsoekonomiska aspekter beskrivs närmare i denna rapport.

  • 2.
    Akhavan, Sharareh
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Temaledare: Vård på lika villkor – Vad kan vi lära av Lärandeprojektet?2015In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 92, no 2, p. 103-106Article in journal (Other academic)
  • 3.
    Akhavan, Sharareh
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Practice and Policy in Promoting Health and Equity –experiences from a national project in primary health care in Sweden2016Conference paper (Refereed)
    Abstract [en]

    Introduction: The Swedish Health Care Law requires the health system to provide good care on equal terms to all. However, several reports from different governmental agencies have revealed that health care is uneven in quality, lacking in accessibility, and not offered on equal terms to all people. Recent public health reports show that inequalities in health in the population have increased. To provide health care on equal terms has become a challenge for health care.

    In order to apply methods for developing practice and policy in promoting health and equity the Swedish Association of Local Authorities and Regions developed and implemented a national project entitled Care on Equal Terms. The project began in 2011 and was completed in 2014 at seven Primary Health Care Units (PHCUs) in five regions. The aim of this study was to evaluate the outcomes of this project.

    Methods: Based on a program theoretical approach an evaluation design was developed which included process, results and economical evaluation. In the data collection and analysis mixed methods were applied.

    Results: According to the process evaluation, seven different strategies were applied in the process to develop primary health care on equal terms. One of the key observations was that in order to achieve health on more equal terms, health care needs to be provided on unequal terms, i. e. more needs to be done to reach those who need more assistance to access health services. Health promotion was one of the applied strategies and it was the most common strategy at some of the health care centers with the aim of developing patients' knowledge, awareness and understanding about health, care and self-care. The results evaluation showed that the PHCUs staff identified structural and organizational factors in health care as important factors for developing health promotion and equity in access. The health economic evaluation showed that the costs for implementing the activities for an improved equity were limited. Yet the majority of the PHCUs thought that the detailed regulation of their financing and reporting requirements were a limitation in their work for improved equity. Four of five county councils have recently introduced a primary care provider payment system (ACG) which may not be supportive of efforts to improve equity in access.

    Conclusions: It is possible to develop and maintain practices that can contribute to more equitable care and increase health care personnel’s awareness about practice and policy in promoting health and equity.

  • 4.
    Aytar, Osman
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Akahavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Granath, Marianne
    Sveriges kommuner och landsting.
    Wallin, Hanna
    Sveriges kommuner och landsting.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Using program theory-driven evaluation in primary care units: An integrated evaluation perspective on a learning project providing equitable care in Sweden2013Conference paper (Refereed)
  • 5.
    Aytar, Osman
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Health Care Provider’s Perceptions about and Experiences of Achieving Equitable Health Care: An Evaluation Study2017In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 25, no 5, p. 289-296Article in journal (Refereed)
    Abstract [en]

    Background: In June 2011 the Swedish government signed an agreement with The Swedish Association of Local Authorities and Regions (SALAR), for a three year project to develop and implement “Health care on equal terms.” The project, which involved seven Primary Health Care Units (PHCU) from five county councils in different parts in Sweden, was completed in early 2014. The aim of the project was to develop methods and activities that could promote more equal health care provision in socio-economically disadvantaged areas.

    Aim: To assess and compare health care providers’ experiences of and perceptions about equitable health care at the beginning and end of the national project “Health care on equal terms”.

    Methods: A web survey was sent to all staff at the seven participating Primary Health Care Units (PHCU) at the beginning (2012) and the end (2013) of the project. Data were analyzed with descriptive statistics and the open issues with content analysis.

    Results: In 2013, the percentage of health care providers who reported thinking patients’ ethnicity had no or very little impact on access to care increased, but the proportion of those who reported that they had “no idea” that patients’ gender, age, mental health and physical functioning were significant for access to care was lower in 2013 than in 2012. The results from analysis of the open-ended questions did not show meaningful changes in the respondents’ perceptions of the issues addressed in 2012-2013, but the analysis contributes to a deeper explanation of the answers.

    Conclusion: The main conclusion is that it was possible to implement changes aiming for more equitable care through projects with a focus on learning.

  • 6.
    Bidgoli, Hassan Haghparast
    et al.
    Karolinska institutet, Sweden.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet, Sweden.
    Hasselberg, Marie
    Karolinska institutet, Sweden.
    Pre-hospital trauma care resources for road traffic injuries in a middle-income country-A province based study on need and access in Iran.2011In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 42, no 9, p. 879-884Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran. METHODS: This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities. RESULTS: RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country. CONCLUSIONS: The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.

  • 7.
    Bogg, Lennart
    Department of International Health Care Research and Social Medicine (IHCAR), School of Public Health, Karolinska Institutet, Stockholm, Sweden.
    Family planning in China: out of control?1998In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 88, no 4, p. 649-51Article in journal (Refereed)
    Abstract [en]

    The findings indicate a high number of unregistered female births and are consistent with calls for a rethinking of Chinese population policies in the direction of a more collaborative policy based on female education and participation.

  • 8.
    Bogg, Lennart
    Karolinska institutet, Stockholm, Sweden.
    Health insurance in rural Africa1995In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 345, no 8948, p. 521-522Article in journal (Refereed)
  • 9.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. lennart.bogg@ki.se.
    Primärvårdens ersättnings- och styrsystem i förändring: ACG - Kejsarens nya kläder?2015In: Socialmedicinsk Tidskrift, ISSN 0037-833X, ISSN ISSN 0037-833X, Vol. 92, no 2, p. 70-86, article id 1277Article in journal (Refereed)
    Abstract [sv]

    Utvärderingen av SKL-projektet ’Vård på Lika Villkor’ visade att primärvårdensersättnings- och styrsystem genomgått stora förändringar under senare årmed olika utformning i landstingen. Primärvårdens ersättnings- och styrsystemi samtliga landsting i Sverige beskrivs och analyseras med särskild fokus påACG-systemet i en litteraturanalys med avseende på ACG-systemets effekterpå vårdens jämlikhet, innehåll kvalitet och effektivitet. Totalt har 51 relevantaartiklar analyserats. Slutsatsen är att studierna huvudsakligen avsett ACGsystemetsförmåga att predikera framtida vårdbehov, men att ingen av deanalyserade artiklarna har studerat effekter på vårdens jämlikhet, innehåll,kvalitet eller effektivitet. En brittisk studie visar dessutom att det finns en mycketenklare och mindre kostsam metod som dessutom predikerar vårdbehov bättreän ACG.

  • 10.
    Bogg, Lennart
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institutet, Stockholm, Sweden.
    Diwan, V.
    Karolinska Institutet, Stockholm, Sweden.
    Vora, K. S.
    Indian Institute of Public Health, Gandhinagar, Gujarat, India.
    DeCosta, A.
    Karolinska Institutet, Stockholm, Sweden.
    Impact of Alternative Maternal Demand-Side Financial Support Programs in India on the Caesarean Section Rates: Indications of Supplier-Induced Demand2016In: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 20, no 1, p. 11-15Article in journal (Refereed)
    Abstract [en]

    Background: This paper examines two state-led public–private demand-side financial support programs aiming to raise hospital delivery rates in two neighbouring Indian states—Gujarat and Madhya Pradesh. The national Janani Suraksha Yojana (JSY) was complemented with a public–private partnership program Janani Sahayogi Yojana (JSaY) in Madhya Pradesh in which private obstetricians were paid to deliver poor women. A higher amount was paid for caesarean sections (CS) than for vaginal deliveries (VD). In Gujarat state, the state program Chiranjeevi Yojana (CY) paid private obstetricians a fixed amount for a block 100 deliveries irrespective of delivery mode. The two systems thus offered an opportunity to observe the influence of supplier-induced demand (SID) from opposite incentives related to delivery mode. Methods: The data from the two programs was sourced from the Departments of Health and Family Welfare, Governments of Gujarat and Madhya Pradesh, India. Results: In JSaY program the CS rate increased from 26.6 % (2007–2008) to 40.7 % (2010–2011), against the background rate for CS in Madhya Pradesh, of only 4.9 % (2004–2006). Meanwhile in CY program in Gujarat, the CS rate decreased to 4.3 % (2010–2011) against a background CS rate of 8.1 % (2004–2006). Conclusions: The findings from India are unique in that they not only point to a significant impact from the introduction of the financial incentives but also how disincentives have an inverse impact on the choice of delivery method.

  • 11.
    Bogg, Lennart
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Diwan, Vinod
    Karolinska institutet, Stockholm, Sweden.
    Tuberculosis control in China1996In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 347, no 9016, p. 1702-1702Article in journal (Refereed)
  • 12.
    Bogg, Lennart
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Dong, Hengjin
    Zhejiang University, School of Public Health, China.
    An Economic Insight into Health Care in Six Chinese Counties: Equity in Crisis2010In: International Health & Aid Policies: the Need for Alternatives / [ed] Unger, Jean-Pierre; De Paepe, Pierre; Sen, Kasturi; Soors, Werner, Cambridge University Press, 2010, p. 123-137Chapter in book (Refereed)
    Abstract [en]

    Objectives:

    To assess inequity in health care financing and utilisation, its associated socio-economic variables and consequences, with focus on the impact of alternative health financing systems.

     

    Methods

    Econometric and multivariate analysis of cross-sectional and retrospective household survey data from six counties in three provinces in Central China.

     

    Findings:

    The old Cooperative Medical System (CMS) was associated with a five times less risk of financial difficulties, half the risk of care-induced debt (non-significant, 95%CI 0.2-1.1) and not one CMS participant having to forego care due to cost. CMS was associated with better health, three times less risk of illness with duration of at least one month. Other health insurance systems were associated with higher risk of illness, higher outpatient expenditure without evidence of reducing barriers to care. The elderly (60 years +) had a more than five times increased risk of illness for at least one month, (OR = 5.2, 95%CI = 3.2-8.3). The illness concentration index confirmed that the poor suffer from a higher prevalence of morbidity. The Le Grand index confirmed strong bias in utilisation favouring the rich. The Kakwani index confirmed an extremely high degree of regressivity in the financing of health services, (-0.73) for outpatient and (-0.94) for inpatient services. The New Cooperative Medical System (NCMS) differs from the old CMS in critical aspects.

  • 13.
    Bogg, Lennart
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Dong, Hengjin
    Department of Health Statistics and Community Medicine .
    Wang, Keli
    Shanghai Medical University, People's Republic of China.
    Cai, Wenwei
    Shanghai Medical University, People's Republic of China.
    Vinod, Diwan
    Karolinska institutet, Stockholm, Sweden.
    The cost of coverage: rural health insurance in China1996In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 11, no 3, p. 238-52Article in journal (Refereed)
    Abstract [en]

    China has undergone great economic and social change since 1978 with far reaching implications for the health care system and ultimately for the health status of the population. The Chinese Medical Reform of the 1980s made cost recovery a primary objective. The urban population is mostly protected by generous government health insurance. A high share government budget is allocated to urban health care. Rural cooperative health insurance reached a peak in the mid-1970s when 90% of the rural population were covered. In the 1980s rural cooperative health insurance collapsed and present coverage is less than 8%. The decline has been accompanied by reports of growing equity problems in the financing of and access to health care. This article is the first in a four-year study of the impact on equity of the changes in Chinese health care financing. The article examines the relationship between rural cooperative health insurance as the explanatory variable and health care expenditure, curative vs. preventive expenditure and tertiary curative care expenditure as dependent variables using a natural experimental design with a 'twin' county as a control. The findings support the hypothesis that cooperative health insurance will induce higher growth of health care expenditure. The findings also support the hypothesis that cooperative health insurance will lead to a shift from preventive medicine to curative medicine and to a higher level of tertiary curative care expenditure. The empirical evidence from the Chinese counties is contradicting World Bank health financing policies.

  • 14.
    Bogg, Lennart
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Huang, Kun
    Anhui Medical University.
    Shen, Yuan
    Xi'an Jiaotong University.
    Long, Qian
    Chongqing Medical University.
    Hemminki, Elina
    National Institute for Health and Welfare, Finland .
    Dramatic Increase of Cesarean Deliveries in the Midst of Health Reforms in Rural China2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1544-1549Article in journal (Refereed)
    Abstract [en]

    Cesarean delivery (CD) rates were until recently low in rural China where the population lacked healthinsurance. In July 2003 the New Cooperative Medical Scheme (NCMS) was introduced. We report findingsfrom a health systems study carried out in the EC-funded project ‘‘Structural hinders to andpromoters of good maternal care in rural China’’ in central and western China. The purpose was toanalyze how CD rates changed with the increased level of funding of the NCMS.The research design was a natural experiment. Quantitative demographic, administrative and accountsdata for 2001–2007 were collected in five counties from the county public health bureaux, the countyNCMS offices, the county statistical offices and the Maternal and Child Health (MCH) hospitals, usinga structured data collection form. We found that the CD rates increased in four of the five counties in theperiod 2004–2007 by 36%, 53%, 61% and 131% respectively. In the fifth county the CD rate remained highat 60%. The revenue from CD made up 72–85% of total delivery fee revenue. CD fee revenue increased by97%, 239% and 408% in the three counties with available data; a higher increase than in general healthcare revenue. Our conclusion is that the design of NCMS, the provider payment systems, and therevenue-related bonus systems for doctors need to be studied to rein in the unhealthy increases in ruralCD rates.

  • 15.
    Bogg, Lennart
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderbäck, Maja
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Thailand and Sweden as welfare regimes: examples from the healthcare sector2014Conference paper (Refereed)
    Abstract [en]

    The characteristics of a welfare state is largely related to social justice and welfare reforms. This is mainly in the form of legislation, economic transfers and services that help to ensure that all citizens receive a basic economic security and access to services such as health care and nursing. A key factor for this is a country's economy and political will. In Thailand, there was a strong economic growth during the 1970s. The corresponding development in Sweden took place in the mid 1940's. Health and welfare is the main area of collaboration between the Ministry of Health in Thailand and Mälardalen University. The aim of this study is from a welfare perspective, a comparison of the similarities and differences in the basic elements of the health care systems in Thailand and Sweden.

    The study is based on analysis of national policy documents from Thailand and Sweden as well as from United Nations Agency.

    Both countries emphasize health and welfare from a social rights perspective in constitutions and other laws. E.g. the Thailand Constitution of 2007 states that a person shall enjoy an equal right to receive standard public health service, and the indigent shall have the right to receive free medical treatment from State's infirmary. The Swedish Constitution recognizes that the personal, economic and cultural welfare should be the fundamental goal of public activity through, among other things promote social care and social security, and good conditions for health. In the Swedish Health Care Act of 1982, the goal is a good health and care on equal terms for the entire population.

    Both Thailand and Sweden have a national system of Universal Health Coverage (UHC), which is defined according to World Health Organization (WHO) as ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

    In terms of selected indicators shows for the year 2012 that the Total health expenditure (THE) % of Gross Domestic Product (GDP) amounts in Thailand 4% and 10% in Sweden, general government expenditure on health as % of GDP are 3% resp. 8%, prevention and public health services are 9 resp. 4%, physician density per 1,000 population 0.3 resp. 3.9. The proportion of beds at public/private hospitals are 78/21% resp. 99/1%.

    The example from the health care system shows that the two countries have legislation that emphasizes health as a social right and a public financing of health care. In terms of specific indicators, there are wide variations in terms of costs to society and the individual including prevention and public health services, access to doctors and proportion of beds in public and private hospitals.

  • 16.
    Bogg, Lennart
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Wang, Keli
    School of Public Health, Fudan (Shanghai Medical) University, Shanghai, China.
    Diwan, Vinod
    Karolinska Institutet, Stockholm, Sweden.
    Chinese maternal health in adjustment: claim for life2002In: Reproductive health matters, ISSN 0968-8080, E-ISSN 1460-9576, Vol. 10, no 20, p. 95-107Article in journal (Refereed)
    Abstract [en]

    Health sector reforms in China, instituted starting in 1985, have centred on cost recovery, with fee-for-service revenue replacing public budget funding. The share of public funding for maternal health services was reduced greatly, forcing an increasing proportion of pregnant women to pay for deliveries and treatment of pregnancy-related complications out of pocket, as most had no health insurance to cover these costs. This study aimed to identify socio-economic variables associated with utilisation of essential maternal health services and linked to health sector reforms in China, with a focus on cost recovery. A retrospective household survey (n = 5756) was carried out in six counties in three provinces of Central China in 1995. Antenatal service utilisation continued to improve in 1990-95, but only in relation to the number of visits, which were pre-paid if the woman was participating in a maternal pre-payment scheme or covered by another health insurance scheme. Significant decreases were found in the utilisation of skilled attendance at delivery and hospital delivery, as well as differences in adverse pregnancy outcomes (miscarriages and stillbirths) between women paying out of pocket and those covered by insurance. This study confirms a strong association between utilisation of delivery services and financing variables of amount of savings in the bank, maternal pre-payment schemes and health insurance. It also shows the critical importance of out-of-pocket, fee-for-service payments for maternity care as a barrier to the utilisation of these services.

  • 17.
    Clarke, Marina
    et al.
    Cape Peninsula University of Technology, Cape Town , South Africa; Karolinska Institutet, Stockholm, Sweden.
    Dick, Judy
    Medical Research Council of South Africa, Cape Town, South Africa.
    Bogg, Lennart
    Mälardalen University, School of Business. Karolinska Institutet, Stockholm, Sweden.
    Cost-effectiveness analysis of an alternative tuberculosis management strategy for permanent farm dwellers in South Africa amidst health service contraction2006In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, no 1, p. 83-91Article in journal (Refereed)
    Abstract [en]

    TB control has suffered from budget reductions in South Africa. It is critically important to develop cost-effective strategies to reduce the TB burden. Costs to public budgets can be substantially reduced while maintaining or improving case detection and treatment outcomes, by using farm-based LHWs.

  • 18.
    De Costa, Ayesha
    et al.
    Karolinska Institutet.
    Shet, Anita
    St Johns Colege, Bangalore.
    Kumarasamy, N
    YRG Care, Madras.
    Ashorn, Per
    Åbo University.
    Eriksson, Bo
    Nordic School of Public Health.
    Bogg, Lennart
    Diwan, Vinod
    Karolinska Institutet.
    Design of a randomized trial to evaluate the influence of mobile phone reminders on adherence to first line antiretroviral treatment in South India: the HIVIND study protocol2010In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 10, no 25Article in journal (Refereed)
    Abstract [en]

    Poor adherence to antiretroviral treatment has been a public health challenge associated with the treatment of HIV. Although different adherence-supporting interventions have been reported, their long term feasibility in low income settings remains uncertain. Thus, there is a need to explore sustainable contextual adherence aids in such settings, and to test these using rigorous scientific designs. The current ubiquity of mobile phones in many resource-constrained settings, make it a contextually appropriate and relatively low cost means of supporting adherence. In India, mobile phones have wide usage and acceptability and are potentially feasible tools for enhancing adherence to medications. This paper presents the study protocol for a trial, to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India.

    Methods/Design: 600 treatment naive patients eligible for first-line treatment as per the national antiretroviral treatment guidelines will be recruited into the trial at two clinics in South India. Patients will be randomized into control and intervention arms. The control arm will receive the standard of care; the intervention arm will receive the standard of care plus mobile phone reminders. Each reminder will take the form of an automated call and a picture message. Reminders will be delivered once a week, at a time chosen by the patient. Patients will be followed up for 24 months or till the primary outcome i.e. virological failure, is reached, whichever is earlier. Self-reported adherence is a secondary outcome. Analysis is by intention-to-treat. A cost-effectiveness study of the intervention will also be carried out.

    Stepping up telecommunications technology in resource-limited healthcare settings is a priority of the World Health Organization. The trial will evaluate if the use of mobile phone reminders can influence adherence to first-line antiretrovirals in an Indian context.

  • 19. Dong, H
    et al.
    Bogg, Lennart
    Rehnberg, C
    Diwan, V
    Health financing policies. Providers' opinions and prescribing behavior in rural China1999In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 15, no 4, p. 686-98Article in journal (Refereed)
    Abstract [en]

    The empirical data suggest that the main factor influencing provider prescribing behavior is the economic incentives in relation to health care financing for both health care providers and consumers.

  • 20.
    Dong, Hengjin
    et al.
    School of Public Health, Shanghai Medical University, Shanghai, China.
    Bogg, Lennart
    Karolinska institutet, Stockholm, Sweden.
    Rehnberg, Clas
    Stockholm School of Economics, Stockholm, Sweden.
    Diwan, Vinod
    Karolinska institutet, Stockholm, Sweden; Nordic School of Public Health, Gothenburg, Sweden.
    Association between health insurance and antibiotics prescribing in four counties in rural China1999In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 48, no 1, p. 29-45Article in journal (Refereed)
    Abstract [en]

    A cross-sectional study was carried out at county, township and village health care facilities in four counties in rural China in order to describe and compare the effects of health financing systems on antibiotic prescribing in outpatient care. A total of 1232 outpatients at the health care facilities was selected by multi-stage random sampling and were interviewed over 2 weeks. The results showed that health financing systems appeared to influence antibiotic prescribing in outpatient care, both in terms of frequency and of the types prescribed. The insured group had lower prescribing of antibiotics at township and village health care facilities, and for respiratory tract infections, but had higher prescribing of newer antibiotics at county and village health care facilities, for respiratory tract and g-i infections. Because there was a high patient compliance rate (94.3%) in this study the prescribing of antibiotics (supply side behavior) reflected the use of antibiotics (demand side behavior) to a great extent. Thus the results imply that antibiotics prescribing and using might be biased by the patient's health financing systems and antibiotic prescribing was the result of the interaction between physicians and patients.

  • 21.
    Dong, Hengjin
    et al.
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Rehnberg, Clas
    Stockholm School of Economics.
    Diwan, Vinod
    Karolinska institutet.
    Drug policy in China: pharmaceutical distribution in rural areas.1999In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 48, no 6, p. 777-786Article in journal (Refereed)
    Abstract [en]

    In 1978, China decided to reform its economy and since then has gradually opened up to the world. The economy has grown rapidly at an average of 9.8% per year from 1978 to 1994. Medical expenditure, especially for drugs, has grown even more rapidly. The increase in medical expenditure can be attributed to changing disease patterns, a higher proportion of older people in the population and fee-for-service incentives for hospitals. Due to the changing economic system and higher cost of health care, the Chinese government has reformed its health care system, including its health and drug policy. The drug policy reform has led to more comprehensive policy elements, including registration, production, distribution, utilization and administration. As a part of drug policy reform, the drug distribution network has also been changed, from a centrally controlled supply system (push system) to a market-oriented demand system (pull system). Hospitals can now purchase drugs directly from drug companies, factories and retailers, leading to increased price competition. Patients have easier access to drugs as more drugs are available on the market. At the same time, this has also entailed negative effects. The old drug administrative system is not suitable for the new drug distribution network. It is easy for people to get drugs on the market and this can lead to overuse and misuse. Marketing factors have influenced drug distribution so strongly that there is a risk of fake or low quality drugs being distributed. The government has taken some measures to fight these negative effects. This paper describes the drug policy reform in China, particularly the distribution of drugs to health care facilities.

  • 22.
    Dong, Hengjin
    et al.
    School of Public Health, Shanghai Medical University, Shanghai, China.
    Bogg, Lennart
    Karolinska institutet, Stockholm, Sweden.
    Wang, Keli
    School of Public Health, Shanghai Medical University, Shanghai, China.
    Rehnberg, Clas
    Stockholm School of Economics, Stockholm, Sweden.
    Diwan, Vinod
    Nordic School of Public Health, Gothenburg, Sweden; Karolinska institutet, Stockholm, Sweden.
    A description of outpatient drug use in rural China: evidence of differences due to insurance coverage1999In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 14, no 1, p. 41-56Article in journal (Refereed)
    Abstract [en]

    This paper describes the effects of health financing systems (insurance) on outpatient drug use in rural China. 1320 outpatients were interviewed (exit interview) in the randomly selected county, township and village health care facilities in five counties in three provinces of central China. The interview was face to face. Questions were asked by a trained interviewer and were answered by patient him/herself. The main finding was that health insurance appeared to influence drug use in outpatient services. The average number of drugs per visit was 2.56 and drug expenditures per visit was 16.9 yuan. Between insured and uninsured (out-of-pocket) groups, there were significant differences in the number of drugs and drug expenditures per visit. The insured had a lower number of drugs and a higher drug expenditure per visit than the uninsured, implying the use of more expensive drugs per visit than the uninsured. There were also significant differences in the number of drugs and drug expenditures per visit between the types of insurance. One third of the drugs were anti-infectives, most of which were penicillin, gentamycin, and sulfonamides. The results imply that uninsured patients do not receive the same care as the insured do even if they have the same needs. The fee-for-service financing for hospitals and health insurance have changed health providers' and consumers' behaviour and resulted in the increase of medical expenditure.

  • 23.
    Dong, Hengjin
    et al.
    Zhejiang University, Center for Health Policy Studies, China.
    Duan, Shengnan
    Zhejiang University, Center for Health Policy Studies, China.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska institutet, Global health, Sweden.
    Wu, Yuan
    Zhejiang University, Center for Health Policy Studies, China.
    You, Hua
    Zhejiang University, Center for Health Policy Studies, China.
    Chen, Jinhua
    Zhejiang University, Center for Health Policy Studies, China.
    Ye, Xujun
    Zhejiang University, Center for Health Policy Studies, China.
    Seccombe, Karen
    School of Community Health, Portland State University, Portland, Oregon, USA.
    Yu, Hai
    Zhejiang University, Center for Health Policy Studies, China.
    The impact of expanded health system reform on governmental contributions and individual copayments in the new Chinese rural cooperative medical system2016In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 31, no 1, p. 36-48Article in journal (Refereed)
    Abstract [en]

    In 2002, the Chinese central government created a new rural cooperative medical system (NCMS), ensuring that both central and local governments partner with rural residents to reduce their copayments, thus making healthcare more affordable. Yet, significant gaps in health status and healthcare utilization persisted between urban and rural communities. Therefore, in 2009, healthcare reform was expanded, with (i) increased government financing and (ii) sharply reduced individual copayments for outpatient and inpatient care. Analyzing data from China's Ministry of Health, the Rural Cooperative Information Network, and Statistical Yearbooks, our findings suggest that healthcare reform has reached its preliminary objectives-government financing has grown significantly in most rural provinces, especially those in poorer western and central China, and copayments in most rural provinces have been reduced. Significant intraprovincial inequality of support remains. The central government contributes more money for poor provinces than for rich ones; however, NCMS schemes operate at the county level, which vary significantly in their level of economic development and per capital gross domestic products (GDP) within a province. Data reveal that the compensation ratios for both outpatient and inpatient care are not adjusted to compensate for a rural county's level of economic development or per capita GDP. Consequently, a greater financial burden for healthcare persists among persons in the poorest rural regions. A recommendation for next step in healthcare reform is to pool resources at prefectural/municipal level and also adjust central government contributions according to the GDP level at prefectural/municipal level.

  • 24.
    Gustafsson, Gunnel
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Aytar, Osman
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Områdesbeskrivningar av sju vårdverksamheter: Primärvårdens förutsättningar och befolkningens vårdbehov2014Report (Other academic)
    Abstract [sv]

    Lärandeprojektet Vård på lika villkor har varit en överenskommelse mellan staten och Sveriges Kommuner och Landsting som pågått mellan 2011 och 2014. Målet med projektet har varit att utveckla arbetssätt och metoder som kan främja en mer jämlik första linjens vård. Inom ramen för projektet har SKL uppdragit åt forskare vid Mälardalens högskola att göra områdesbeskrivningar för de sju medverkande vårdverksamheterna.

    Syftet med områdesbeskrivningarna är försöka ge en jämförbar beskrivning av de medverkande sju verksamheterna i projektet. Beskrivningen är gjord utifrån relevant statistik och demografi ska data på patientnivå, samt utifrån organisatoriska förutsättningar och resurser. Förhoppningen är att dessa uppgifter kan ge ökad förståelse för vilka patienter som fi nns i området och fungera som ett stöd i arbetet för en mer jämlik vård.

  • 25.
    Haghparast-Bidgoli, Hassan
    et al.
    Karolinska Inst, Sverige.
    Saadat, Soheil
    Univ Tehran, Iran.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska institutet, Sverige.
    Yarmohammadian, Mohammad Hossein
    Isfahan Univ, Iran.
    Hasselberg, Marie
    Karolinska Inst, Sverige.
    Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, p. Article Number: 281-Article in journal (Refereed)
    Abstract [en]

    Background: Road traffic injuries (RTIs) are a substantial cause of mortality and disability globally. There is little published information regarding healthcare resource utilization following RTIs, especially in low and middle-income countries (LMICs). The aim of this study was to assess total hospital charges and length of stay (LOS) associated with RTIs in Iran and to explore the association with patients' socio-demographic characteristics, insurance status and injury-related factors (e. g. type of road users and safety equipment). Method: The study was based on the Iranian National Trauma Registry Database (INTRD), which includes data from 14 general hospitals in eight major cities in Iran, for the years 2000 to 2004. 8,356 patients with RTI admitted to the hospitals were included in the current study. The variables extracted for the analysis included total hospital charges and length of stay, age, gender, socio-economic and insurance status, injury characteristics, medical outcome and use of safety equipment among the patients. Univariable analysis using non-parametric methods and multivariable regression analysis were performed to identify the factors associated with total hospital charges and LOS. Results: The mean hospital charges for the patients were 1,115,819 IRR (SD=1,831,647 IRR, US$128 +/- US$210). The mean LOS for the patients was 6.8 (SD =8 days). Older age, being a bicycle rider, higher injury severity and longer LOS were associated with higher hospital charges. Longer LOS was associated with being male, having lower education level, having a medical insurance, being pedestrian or motorcyclist, being a blue-collar worker and having more severe injuries. The reported use of safety equipment was very low and did not have significant effect on the hospital charges and LOS. Conclusion: The study demonstrated that the hospital charges and LOS associated with RTI varied by age, gender, socio-economic status, insurance status, injury characteristics and health outcomes of the patients. The results of the study provide information that can be of importance in the planning and design of road traffic injury control strategies.

  • 26.
    Huang, K
    et al.
    School of Public Health, Anhui Medical University, Hefei City, Anhui Province, China.
    Tao, F
    School of Public Health, Anhui Medical University, Hefei City, Anhui Province, China.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Tang, S
    Duke Global Health Institute, Duke University, USA.
    Impact of alternative reimbursement strategies in the new cooperative medical scheme on caesarean delivery rates: A mixed-method study in rural China2012In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, ISSN 1472-6963, Vol. 12, no 1, p. Article number 217-Article in journal (Refereed)
    Abstract [en]

    Background: The rate of caesarean delivery (CD) in rural China has been rapidly increasing in recent decades. Due to the exorbitant costs associated with CD, paying for this expensive procedure is often a great challenge for the majority of rural families. Since 2003, the Chinese government has re-established the NewCooperative Medical Scheme (NCMS), aimed to improve the access of essential healthcare to rural residents and reduce financial burden owing to high out of pocket payments. This paper seeks to test the hypothesis that NCMS may provide service users and providers with financial incentives to select CD. It also assesses the effect of different health insurance reimbursement strategies of NCMS on CD rates in rural China. Methods: Mixed quantitative and qualitative methods were adopted for data collection. Two cross-sectional household surveys were conducted with women having babies delivered in 2006 and 2009; 2326 and 1515 women, respectively, from the study sites were interviewed using structured questionnaires, to collect demographic and socio-economic data, maternal and child care characteristics and health-related expenditures. Focus group discussions (FGDs) and in-depth key informant interviews (KIIs) were undertaken with policy makers, health managers, providers and mothers to understand their perceptions of the influence of NCMS on the choices of delivery mode. Results: The CD rates in the two study counties were 46.0 percent and 64.7 percent in 2006, increasing to 63.6 percent and 82.1 percent, respectively, in 2009. The study found that decisions on the selection of CD largely came from the pregnant women. Logistic regression analysis, after adjusting for socio-economic, maternal and fetal characteristics, did not indicate a significant effect of either proportional reimbursement or fixed amount reimbursement on the choice of CD for both study years. Interviews with stakeholders reflected that different reimbursable rates for CD and vaginal deliveries did not have a significant effect on controlling the rising CD rate in the study countries. Conclusion: NCMS reimbursement strategies adopted in the study counties of China did not have a significant effect on the selection of CD for babydeliveries. The rapid rise of the CD rates of rural China has remained a serious issue. Other effective measures, such as health education to increase awareness of mothers' knowledge, an improving training of health staff in evidence-based delivery care, maybe could do more to promote rational baby delivery in rural China.

  • 27.
    Long, Qian
    et al.
    University of Helsinki, Finland.
    Zhang, Yaoguang
    Ministry of Health, Beijing, China.
    Raven, Joanna
    Liverpool School of Tropical Medicine, Liverpool, United Kingdom .
    Wu, Zhuochun
    Fudan University.
    Bogg, Lennart
    Karolinska institutet.
    Tang, Shenglan
    Liverpool School of Tropical Medicine, Liverpool, United Kingdom .
    Hemminki, Elina
    National Institute for Health and Welfare, Helsinki, Finland .
    Giving birth at a health-care facility in rural China: is it affordable for the poor?2011In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 89, no 2, p. 144-152Article in journal (Refereed)
    Abstract [en]

    Expenditure on facility-based delivery greatly increased in rural China over 1998-2007 because of greater use of higher-level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high.

  • 28.
    Meng, Qingyue
    et al.
    Shandong University.
    Yu, Baorong
    Shandong University.
    Cha, J
    Liu, XY
    Liverpool University, School of Tropical Medicine.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Dobberscheutz, Karin
    Fei, Yan
    Fudan University, Shanghai.
    Tang, Shenglan
    WHO/TDR.
    Tolhurst, Rachel
    Liverpool University, School of Tropical Medicine.
    Changing equity in China’s New Cooperative Medical Scheme: a repeated cross-sectional study in two provinces2010Manuscript (preprint) (Other (popular science, discussion, etc.))
  • 29.
    Pan, Jianying
    et al.
    Zhejiang University School of Management, GERC,Hangzhou.
    Wang, Zhongming
    Zhejiang University School of Management, GERC,Hangzhou.
    Segelod, Esbjörn
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Bogg, Lennart
    Mälardalen University, School of Sustainable Development of Society and Technology. Mälardalen University, School of Health, Care and Social Welfare.
    Differential effect of multi-level science parks on motives and performance of high-tech firms under change in China2012In: International Journal of Psychology, ISSN 0020-7594, E-ISSN 1464-066X, Vol. 47, no 1, p. 515-515Article in journal (Refereed)
  • 30.
    Rodrigues, Rashmi
    et al.
    St John's National Academy of Health Sciences, Bangalore, India.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska institutet, Global health, Sweden.
    Shet, Anita
    St John's National academy of Health Sciences, Bangalore, India.
    Kumar, Dodderi Sunil
    Karnataka AIDS Prevention Society, Bangalore, India.
    De Costa, Ayesha
    Karolinska institutet, Sweden.
    Mobile phones to support adherence to antiretroviral therapy: what would it cost to the Indian National AIDS Control Programme?2014In: Journal of the International AIDS Society, ISSN 1758-2652, E-ISSN 1758-2652, Vol. 17, p. Article Number: 19036-Article in journal (Refereed)
    Abstract [en]

    Introduction: Adherence to antiretroviral treatment (ART) is critical to maintaining health and good clinical outcomes in people living with HIV/AIDS. To address poor treatment adherence, low-cost interventions using mobile communication technology are being studied. While there are some studies that show an effect of mobile phone reminders on adherence to ART, none has reported on the costs of such reminders for national AIDS programmes. This paper aims to study the costs of mobile phone reminder strategies (mHealth interventions) to support adherence in the context of India's National AIDS Control Program (NACP). Methods: The study was undertaken at two tertiary level teaching hospitals that implement the NACP in Karnataka state, South India. Costs for a mobile phone reminder application to support adherence, implemented at these sites (i.e. weekly calls, messages or both) were studied. Costs were collected based on the concept of avoidable costs specific to the application. The costs that were assessed were one-time costs and recurrent costs that included fixed and variable costs. A sequential procedure for costing was used. Costs were calculated at national-programme level, individual ART-centre level and individual patient level from the NACP's perspective. The assessed costs were pooled to obtain an annual cost per patient. The type of application, number of ART centres and number of patients on ART were varied in a sensitivity analysis of costs. Results: The Indian NACP would incur a cost of between 79 and 110 INR (USD 1.27 - 1.77) per patient per year, based on the type of reminder, the number of patients on ART and the number of functioning ART centres. The total programme costs for a scaleup of the mHealth intervention to reach the one million patients expected to be on treatment by 2017 is estimated to be 0.36% of the total five-year national-programme budget. Conclusions: The cost of the mHealth intervention for ART-adherence support in the context of the Indian NACP is low and is facilitated by the low cost of mobile communication in the country. Extending the use of mobile communication applications beyond adherence support under the national programme could be done relatively inexpensively.

  • 31.
    Sun, Qiang
    et al.
    Fudan University.
    Yan, Fei
    Fudan University.
    Wang, Wei
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Tang, Shenglan
    Liverpool School of Hygiene and Tropical Medicine.
    Analysis of appropriate use of pharmaceuticals in rural three-tier medical institutions in Shandong and Ningxia2010In: Chinese health services management (Zhongguo Weisheng Shiye Guanli), ISSN 1004-4663, Vol. 8, p. 535-537-556Article in journal (Refereed)
  • 32.
    Sun, Qiang
    et al.
    Fudan University.
    Yin, Jia
    Fudan University.
    Yan, Fei
    Fudan University.
    Wang, Wei
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Tang, Shenglan
    Liverpool School of Hygiene and Tropical Medicine.
    Analysis of the use of prescription antibiotics at outpatient clinics in rural three-level medical institutions in Shandong and Ningxia provinces2010In: Chinese Health Economics, ISSN 1003-0743, Vol. 4Article in journal (Refereed)
  • 33.
    Sun, Qiang
    et al.
    Fudan University.
    Yin, Jia
    Fudan University.
    Zuo, Zuo
    Wang, Wei
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet, Stockholm, Sweden.
    Tang, Shenglan
    The Analysis of the use of Prescription Antibiotics at Outpatient Clinics in Rural Three-level Medical Institutions in Shandong and Ningxia Province2010In: Chinese Health Economics, ISSN 1003-0743, Vol. 2010, no 4, p. 55-57Article in journal (Refereed)
  • 34.
    Walusimbi, S.
    et al.
    epartment of Microbiology, Makerere University, College of Health Sciences, Kampala, Uganda.
    Kwesiga, B.
    HealthNet Consult, Kampala, Uganda.
    Rodrigues, R.
    Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
    Haile, M.
    Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden.
    De Costa, A.
    Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
    Katamba, A.
    Department of Medicine, Clinical Epidemiology Unit, Makerere University, College of Health Sciences, Kampala, Uganda.
    Cost-effectiveness analysis of microscopic observation drug susceptibility test versus Xpert MTB/Rif test for diagnosis of pulmonary tuberculosis in HIV patients in Uganda2016In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 1, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: Microscopic Observation Drug Susceptibility (MODS) and Xpert MTB/Rif (Xpert) are highly sensitive tests for diagnosis of pulmonary tuberculosis (PTB). This study evaluated the cost effectiveness of utilizing MODS versus Xpert for diagnosis of active pulmonary TB in HIV infected patients in Uganda. Methods: A decision analysis model comparing MODS versus Xpert for TB diagnosis was used. Costs were estimated by measuring and valuing relevant resources required to perform the MODS and Xpert tests. Diagnostic accuracy data of the tests were obtained from systematic reviews involving HIV infected patients. We calculated base values for unit costs and varied several assumptions to obtain the range estimates. Cost effectiveness was expressed as costs per TB patient diagnosed for each of the two diagnostic strategies. Base case analysis was performed using the base estimates for unit cost and diagnostic accuracy of the tests. Sensitivity analysis was performed using a range of value estimates for resources, prevalence, number of tests and diagnostic accuracy. Results: The unit cost of MODS was US$ 6.53 versus US$ 12.41 of Xpert. Consumables accounted for 59 % (US$ 3.84 of 6.53) of the unit cost for MODS and 84 % (US$10.37 of 12.41) of the unit cost for Xpert. The cost effectiveness ratio of the algorithm using MODS was US$ 34 per TB patient diagnosed compared to US$ 71 of the algorithm using Xpert. The algorithm using MODS was more cost-effective compared to the algorithm using Xpert for a wide range of different values of accuracy, cost and TB prevalence. The cost (threshold value), where the algorithm using Xpert was optimal over the algorithm using MODS was US$ 5.92. Conclusions: MODS versus Xpert was more cost-effective for the diagnosis of PTB among HIV patients in our setting. Efforts to scale-up MODS therefore need to be explored. However, since other non-economic factors may still favour the use of Xpert, the current cost of the Xpert cartridge still needs to be reduced further by more than half, in order to make it economically competitive with MODS.

  • 35.
    Wang, Wei
    et al.
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Sun, Qiang
    Fudan University.
    Yan, Fei
    Fudan University.
    Tang, Shenglan
    Liverpool School of Hygiene and Tropical Medicine.
    Analysing the status of drug use in medical institutions at county, township and village levels in Shandong and Ningxia2010In: Chinese health services management (Zhongguo Weisheng Shiye Guanli), ISSN 1004-4663, Vol. 08, no 535Article in journal (Refereed)
  • 36.
    Xu, Biao
    et al.
    School of Public Health, Fudan University, Fudan, China; Karolinska Institutet, Stockholm, Sweden.
    Diwan, Vinod K
    Karolinska Institutet, Stockholm, Sweden.
    Bogg, Lennart
    Mälardalen University, School of Business. Karolinska Institutet, Stockholm, Sweden.
    Access to tuberculosis care: what did chronic cough patients experience in the way of healthcare-seeking?2007In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no 4, p. 396-402Article in journal (Refereed)
    Abstract [en]

    Potential TB patients' access to TB care needs improving under DOTS. The expenses for treatment of cough are a heavy burden for the poor. Since the low-income patients first seek care at village health stations or township hospitals for cough, it is vital to involve the general health system in the DOTS project.

  • 37.
    Xu, Biao
    et al.
    School of Public Health, Fudan University, China; Karolinska Institutet, Stockholm, Sweden .
    Dong, Hengjin
    Brunel University, United Kingdom.
    Zhao, Qi
    School of Public Health, Fudan University, China.
    Bogg, Lennart
    Mälardalen University, School of Business. Karolinska Institutet, Stockholm, Sweden; .
    DOTS in China: Removing barriers or moving barriers?2006In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 21, no 5, p. 365-72Article in journal (Refereed)
    Abstract [en]

    In 1992, China initiated its modern National TB Control Programme (NTP) with DOTS strategy through a project funded by a World Bank loan. Key motives for the revised NTP-DOTS were to reduce financial barriers to patients by removing fee charges for diagnosis and treatment, and to address regressive suppliers' incentives for appropriate referrals. This study aims to assess to what extent China's NTP subsidies are achieving the objective of removing financial barriers to care in terms of patients' expenditure. One county with NTP-DOTS - Jianhu - and one county without - Funing - were selected. A cohort of 493 tuberculosis patients newly diagnosed in 2002 was interviewed by questionnaire. The main outcome measure was tuberculosis patients' expenditure on medical care and transportation/accommodation from the onset of symptoms to treatment completion. During the follow-up period, Funing started implementing NTP-DOTS, which offered a possibility of longitudinal comparison both between counties and within county. Ninety-four per cent (465/493) of subjects were followed-up. The mean total patient's expenditure on TB medical care and transportation/accommodation before TB diagnosis was higher in Jianhu than in Funing (715 vs. 256CNY), whereas it was higher in Funing (835 vs. 157CNY) after diagnosis. After implementing NTP-DOTS in Funing, expenditure after diagnosis decreased slightly whereas expenditure before diagnosis increased remarkably. We found that the market incentive structures in the reformed health system appear to have a stronger regressive effect and may result in prolonged delays before effective treatment can be given. We believe that doctors adapt to new incentive structures, with bonus income being linked to the hospitals' fee-for-service revenue, and find new ways of keeping revenue at the old levels, which reduce or eliminate the intended effect of the subsidies. TB patients suffer a heavy economic burden even in counties where NTP-DOTS treatment is subsidized. The total patient expenditure was reduced only marginally, but shifted substantially from after diagnosis to before diagnosis. The shift could imply delays in diagnosis and treatment with an increased risk of infection transmission.

  • 38.
    Xu, Biao
    et al.
    Fudan University, Shanghai.
    Fei, Yan
    Fudan University, Shanghai.
    Fochsen, Grethe
    Karolinska Institutet.
    Wang, JM
    Fu, CW
    Bogg, Lennart
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Patients' Perceptions of Health System Barriers to Access to Tuberculosis Care in Rural China2010Manuscript (preprint) (Other (popular science, discussion, etc.))
  • 39.
    Yan, Fei
    et al.
    Fudan University, China.
    Sun, Qiang
    Fudan University, China.
    Wang, Wei
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Tang, Shenglan
    Liverpool School of Hygiene and Tropical Medicine, UK.
    Analyzing the content of the basic pharmaceutical list for the New Medical Cooperative Scheme (NMCS) and its application in rural areas of Shandong and Ningxia provinces2010In: Chinese health services management (Zhongguo Weisheng Shiye Guanli), ISSN 1004-4663, no 1Article in journal (Refereed)
  • 40.
    Yan, Fei
    et al.
    Fudan University.
    Sun, Qiang
    Fudan University.
    Wang, Wei
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Tang, Shenglan
    Liverpool School of Hygiene and Tropical Medicine.
    Problems and solutions reported in the pilot health insurance for the residents of cities and towns in Shandong province2010In: Chinese health services management (Zhongguo Weisheng Shiye Guanli), ISSN 1004-4663, Vol. 27, no 01Article in journal (Refereed)
  • 41.
    Yan, Weirong
    et al.
    Karolinska Institutet.
    Bogg, Lennart
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Lu, YX
    Zhu, K
    Depressive symptoms and sleep quality in medical college students : a cross-sectional study in central China2010Manuscript (preprint) (Other (popular science, discussion, etc.))
  • 42.
    Ye, Chiyu
    et al.
    Zhejiang University.
    Duan, Shengnan
    Zhejiang University.
    Wu, Yuan
    Zhejiang University.
    Hu, Huimei
    Zhejiang University.
    Liu, Xiaofang
    Zhejiang University.
    You, Hua
    Zhejiang University.
    Wang, Linghao
    Zhejiang University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Dong, Hengjin
    Zhejiang University.
    A preliminary analysis of the effect of the new rural cooperative medical scheme on inpatient care at a county hospital2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 519, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: China in 2009 committed to reach universal health coverage by promoting three forms of health insurance; NCMS for the rural population, UEBMI for formally employed urban residents and URBMI for other urban residents. NCMS has expanded to near universal coverage in rural China since launching in 2003. The objective of this study aimed to assess the effect of NCMS on inpatient care utilization from 2003 to 2012 at Longyou county hospital, Zhejiang province.Methods: The research was conducted at Longyou county, Zhejiang province. All registered inpatient admissions from January 1, 2003, to June 30, 2012, were included in the study. The PLSQL Developer software was used toselect the interesting variables in the hospital information database and saved in an Excel 2003 file. The interesting variables included the patients’ general information (name, gender, age, payment method), discharge diagnosis, length of hospital stay, and expenditure (total expenditure and out-of-pocket payment). Two common diseases (coronary arteriosclerotic disease and pneumonia) were selected as tracer conditions.Results: 292,400 rural residents were enrolled in the Longyou county NCMS by 2011, 95.4% of the eligible population. A total of 145,744 inpatient admissions were registered from 1 January 2003 to 30 June 2012. The proportion ofinpatients covered by NCMS increased from 30.3% in 2004 to 54.2% in 2012 while the proportion of inpatients covered by UEBMI increased from 7.7% in 2003 to 14.7% in 2012. The average expenditure for UEBMI insured inpatients washigher than the average for NCMS insured inpatients, although the gap was narrowing. The average length of hospitalstay increased every year for all inpatients, but was higher for UEBMI inpatients than for NCMS insured inpatients. For both tracer conditions the results were similar to the above findings.Conclusions: NCMS has improved coverage height for its enrollees and resulted in increased cost of care per inpatient admission at the county hospital. However, wide differences persist between the two insurance systems in coverage height. Both systems are associated with increasing lengths of stay and rising cost per inpatient admission. We found that around 30% of inpatients were not covered by any of the two public health insurance systems, which calls for further studies.

  • 43.
    Yin, Jia
    et al.
    Fudan University.
    Sun, Qiang
    Fudan University.
    Yan, Fei
    Fudan University.
    Wang, Wei
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Tang, Shenglan
    Liverpool School of Hygiene and Tropical Medicine.
    Study on medical knowledge and drug-using behaviour of rural residents in Shandong and Ningxia provinces2010In: Chinese Journal of Social Medicine (Zhongguo Shehui Yixue Zazhi), ISSN 1673-5625, Vol. 27, no 3, p. 152-154Article in journal (Refereed)
  • 44.
    Yin, Jia
    et al.
    Fudan University.
    Sun, Qiang
    Fudan University.
    Yan, Fei
    Fudan University.
    Wang, Wei
    Fudan University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Tang, Shenglan
    Liverpool School of Hygiene and Tropical Medicine.
    The current situation of household spare drugs in rural areas of Shandong and Ningxia provinces2010In: Chinese Health Resources (Zhongguo Weisheng Ziyuan), ISSN 1007-953X, Vol. 13, no 1Article in journal (Refereed)
  • 45.
    You, H.
    et al.
    Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China. Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China .
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden .
    Costa, A. D.
    Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden .
    Dong, H.
    Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China. Institute of Public Health, Heidelberg University, Heidelberg, Germany .
    Rural maternal mortality ratio in China2014In: The Lancet Global Health, ISSN 2214-109X, Vol. 2, no 8, p. e451-e452Article in journal (Refereed)
  • 46.
    You, H.
    et al.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Chen, J.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Wu, Y.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Duan, S.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Ye, C.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Liu, X.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Yu, H.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Diwan, V.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Dong, H.
    Center for Health Policy Studies, School of Medicine, Zhejiang University.
    Study on the Factors Associated with Postpartum Visits in Rural China2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 2, p. Artnr. e55955-Article in journal (Refereed)
    Abstract [en]

    Background: Postpartum visits (PPVs) have been advocated as a way to improve health outcomes for mothers and their infants, but the rate of PPVs is still low in rural China. This study aims to investigate the utilization of PPVs and to explore the factors associated with PPVs in rural China. Parity is the most concerned factor in this study. Methods: A cross-sectional household survey was performed in two counties of Zhejiang province. Questions include socio-economic, health services and women's delivery data. Chi-square tests and multivariate logistic regression analyses were performed to identify factors associated with PPVs. Results: 223 women who had a delivery history in the recent five years were enrolled in analyses. 173 (78%) of them were primiparous. Among the primiparous women, 43 (25%) had not received any PPVs. The majority, 27 (55%) of the 49 multiparous women, had not received any PPVs. Multiparous women were less likely to receive PPVs than primiparous women. Among 223 puerperal women, 47 (21%) had been compensated for delivery fee expenses. Women who received compensation were found to be more likely to receive standard (at least 3) PPVs. Conclusions: It was found that women with "second babies" were less likely to use PPVs. This could be an unintended consequence of the "one-child policy", due to fear that contact with public health facilities could result in sanctions. This phenomenon should be taken seriously by government in order to improve the health of babies and their mothers. Financial compensation for delivery fee charges can improve the use of PPVs, thus free-of-charge delivery should be promoted. © 2013 You et al.

  • 47.
    Yu, Baorong
    et al.
    Shandong University.
    Meng, Qingyue
    Shandong University.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Tang, Shenglan
    Liverpool University, School of Tropical Medicine.
    Analysis of health care utilization in rural Shandong and Ningxia2008In: Chinese Health Economics, Vol. 27, no 8, p. 26-28Article in journal (Refereed)
    Abstract [en]

    Study of the sickness prevalence state and utilization of health care for last four weeks for 22,636 rural inhabitants from Shangdong and Ningxia provinces. For last four weeks, 32.8% of the sick inhabitants had visited a health institution, and age, occupation, and education status are factors that affect visiting a doctor or not. Village clinic was the most frequently visited health institution for its geographic convenience; good quality of health care or having an acquaintance was the main reason for selecting township health center, secondary or tertiary hospital; low price was the main reason for selecting a private institution and few people perceived the price in village clinic was low or the quality was good. The mean medical cost of out-of-pocket was 280.0 Chinese Yuan per visit, and accounted for 7.7% of annual net income and 8.7% of annual non-food expenditure per capita. For those fell sick but did not take any measure, 15.9% was because of economic barrier; 9.2% of the outpatients were recommended taking inpatient care, but had not. For outpatients recommended taking inpatient care but had not, 69.7% of them were for economic barrier. Neither the new cooperative medical scheme nor medial aid mechanism has resolved the problem of access to health care.

     

     

     

  • 48. Yu, Baorong
    et al.
    Meng, Qingyue
    Collins, Charles
    Tolhurst, Rachel
    Tang, Shenglan
    Yan, Fei
    Bogg, Lennart
    Liu, Xiaoyun
    How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China2010In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 10, no 1, p. 116-Article in journal (Refereed)
    Abstract [en]

    Outpatient service utilization has not significantly changed under NCMS. Although utilization of inpatient service in general has increased under NCMS, people with high income tend to benefit more than the low income group. While providing financial protection against catastrophic medical expenditure is the principal focus of NCMS, this study recommends that outpatient services should be incorporated in future NCMS policy development. NCMS policy should also be more equity oriented to achieve its policy goal.

  • 49.
    Zhang, Luying
    et al.
    Fudan University, Shanghai.
    Cheng, XM
    Fudan University, Shanghai, China.
    Liu, XY
    Liverpool University, School of Tropical Medicine, UK.
    Zhu, K
    Peking Union Medical College, Beijing, China.
    Tang, Shenglan
    Liverpool University, School of Tropical Medicine, UK.
    Bogg, Lennart
    Karolinska institutet, Sweden.
    Tolhurst, Rachel
    Liverpool University, School of Tropical Medicine, UK.
    Balancing the funds in the New Cooperative Medical Scheme in rural China: determinants and influencing factors in two provinces2010In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 25, no 2, p. 96-118Article in journal (Refereed)
    Abstract [en]

    In recent years, the central government in China has been leading the re-establishment of itsrural health insurance system, but local government institutions have considerable flexibility inthe specific design and management of schemes. Maintaining a reasonable balance of funds iscritical to ensure that the schemes are sustainable and effective in offering financial protectionto members. This paper explores the financial management of the NCMS in China through acase study of the balance of funds and the factors influencing this, in six counties in twoChinese provinces. The main data source is NCMS management data from each county from2003 to 2005, supplemented by: a household questionnaire survey, qualitative interviews andfocus group discussions with all local stakeholders and policy document analysis. The studyfound that five out of six counties held a large fund surplus, whilst enrolees obtained onlypartial financial protection. However, in one county greater risk pooling for enrolees wasaccompanied by relatively high utilisation levels, resulting in a fund deficit. The opportunitiesto sustainably increase the financial protection offered to NCMS enrolees are limited by thefinancial pressures on local government, specific political incentives and low technicalcapacities at the county level and below. Our analysis suggests that in the short term, effortsshould be made to improve the management of the current NCMS design, which shouldbe supported through capacity building for NCMS offices. However, further medium-terminitiatives may be required including changes to the design of the schemes.

  • 50.
    Zhang, Tuohong
    et al.
    Peking University, China.
    Raven, Joanna
    Liverpool School of Hygiene and Tropical Medicine, UK.
    Bogg, Lennart
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Johansson, Eva
    Karolinska institutet, Sweden.
    How effective are national programs on maternal and child health in promoting women's equitable access to health care?2007In: Global Forum for Health Research Forum No. 11, 29 Oct - 2 Nov 2007, e-pub, 2007Conference paper (Refereed)
1 - 50 of 50
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