Umeå Economic Studies, Department of Economics, Umeå University
No 710:
Economic Policy in Health Care: Sickness Absence and Pharmaceutical Cost
David Granlund ()
Abstract: This thesis consists of a summary and four papers. The
first two concerns health care and sickness absence, and the last two
pharmaceutical costs and prices.
Paper [I] presents an economic
federation model which resembles the situation in, for example, Sweden. In
the model the state governments provide health care, the federal government
provides a sickness benefit and both levels tax labor income. The results
show that the states can have either an incentive to under- or over-provide
health care. The federal government can, by introducing an
intergovernmental transfer, induce the state governments to provide the
socially optimal amount of health care.
In Paper [II] the effect of
aggregated public health care expenditure on absence from work due to
sickness or disability was estimated. The analysis was based on data from a
panel of the Swedish municipalities for the period 1993-2004. Public health
care expenditure was found to have no statistically significant effect on
absence and the standard errors were small enough to rule out all but a
minimal effect. The result held when separate estimations were conducted
for women and men, and for absence due to sickness and disability.
The
purpose of Paper [III] was to study the effects of the introduction of
fixed pharmaceutical budgets for two health centers in Västerbotten,
Sweden. Estimation results using propensity score matching methods show
that there are no systematic differences for either price or quantity per
prescription between health centers using fixed and open-ended budgets. The
analysis was based on individual prescription data from the two health
centers and a control group both before and after the introduction of fixed
budgets.
In Paper [IV] the introduction of the Swedish substitution
reform in October 2002 was used as a natural experiment to examine the
effects of increased consumer information on pharmaceutical prices. Using
monthly data on individual pharmaceutical prices, the average reduction of
prices due to the reform was estimated to four percent for both brand name
and generic pharmaceuticals during the first four years after the reform.
The results also show that the price adjustment was not instant.
Keywords: vertical fiscal externalities; sickness absence; sickness benefits; health care expenditure; fixed budgets; pharmaceuticals; cost containment; dynamic panel data models; endogeneity; propensity score matching; (follow links to similar papers)
JEL-Codes: D80; D83; H21; H42; H51; H77; I11; I12; I18; J22; L65; (follow links to similar papers)
129 pages, May 16, 2007
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