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OBJECTIVE: The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status. DESIGN: Observational study combining graphical analysis with linear regressions of cross-sectional administrative practice-level data. SETTING: Three Swedish regions, Västra Götaland, Skåne and Östergötland (3.5 million residents). Outcomes were measured in February 2018 and the CNI was computed based on data for 31 December 2017. SUBJECTS: The unit of analysis was the primary care practice (n = 390). MAIN OUTCOME MEASURES: i) Number of GP visits per registered patient; ii) Number of nurse visits per registered patient; iii) Number of morbidity-weighted GP visits per registered patient; iv) Number of morbidity-weighted nurse visits per registered patient. RESULTS: The linear associations between the CNI and GP visits per patient were positive and statistically significant (p

Additional file 1: Supplementary Table 1. Number of individuals in each subgroup of the population who made at least one healthcare contact in four categories in 2018. Supplementary Table 2. Odds ratio estimates of the odds of having made at least one direct-to-consumer telemedicine physician consultation in 2018 for residents of Region Stockholm above 18 years of age. Supplementary Table 3. Odds ratio estimates of the odds of having made at least one direct-to-consumer telemedicine physician consultation in 2018 for residents of Region Stockholm, by provider

Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county councils in Sweden have implemented risk-adjusted capitation based on the Care Need Index, which increases capitation to primary care centers with a large share of patients with unfavorable socioeconomic and demographic characteristics. Our aim is to estimate the effects of using care-need adjusted capitation on the supply of private primary care centers. We use a dataset that combines information on all primary care centers in Sweden during 2005-2013, the payment system and other conditions for establishing new primary care centers used in the county councils, and demographic, geographic, and socioeconomic variables for low level geographic areas. To estimate the effects of care-need adjusted capitation, we use difference-in-differences models, contrasting the development over time between areas with and without risk-adjusted capitation, and with high and low Care Need Index values. Risk-adjusted capitation significantly increase the number of private primary care centers in areas with relatively high Care Need Index values. The adjustment results in a changed distribution of private centers within county councils; the total number of private centers does not increase in county councils using care-need adjusted capitation. The effects are furthermore increasing over the first three years after the implementation of such capitation, and concentrated to the lower and middle range of the group of areas with high index values. Risk-adjusted capitation based on the Care Need Index increases the supply of private primary care centers in areas with unfavorable socioeconomic and demographic characteristics. More generally, this result indicates that risk-adjusted capitation can significantly affect private providers' establishment decisions.

More recently researchers have turned to analyze how the tax structure, rather than the overall tax level, affects economic performance. For instance, several papers have investigated how taxation on corporate and individual (labor) income influences growth. Taxation of dividend income may also influence growth via its impact on investments and firm behavior. Within the academic community there is conflicting views about the impact taxation of dividends has on firm behavior and, hence, on economic performance. According to the “traditional view”, taxation of dividends is distortionary and increases the cost of equity. According to the “new view”, taxation of dividends does not influence the marginal cost of capital and consequently has no impact on investment decisions. To our knowledge, this paper is the first study to explore how tax rates on dividends affect economic growth, by using panel data from 1990 till 2008 for 18 European countries. We find that taxation of dividend income negatively influences economic growth, a result that corroborates the old view of dividends taxation as distortionary and also has some policy implication for the European countries in question.

Several empirical papers have studied the effect of government size, typically measured as government expenditures, on economic growth. There is no consensus on the direction of this impact, even though more recent studies tend to find a negative relationship between the general level of government expenditures and economic growth. This negative relationship is explained by the distortions that raising tax revenues cause on economic activities. There are, however, several ways to raise tax revenues that likely have different distortionary effects and, hence, may impact economic growth differently. This paper analyses how taxation of income influences economic growth. More precisely we study how statutory tax rates on corporate and personal income affect economic growth by using panel data from 1975 till 2010 for 25 rich OECD countries. We find that both taxation of corporate and personal income negatively influence economic growth. The correlation between corporate income taxation and economic growth is more robust, however.

Several empirical papers have studied the effect of government size, typically measured as government expenditures, on economic growth. There is no consensus on the direction of this impact, even though more recent studies tend to find a negative relationship between the general level of government expenditures and economic growth. This negative relationship is explained by the distortions that raising tax revenues cause on economic activities. There are, however, several ways to raise tax revenues that likely have different distortionary effects and, hence, may impact economic growth differently. This paper analyses how taxation of income influences economic growth. More precisely we study how statutory tax rates on corporate and personal income affect economic growth by using panel data from 1975 till 2010 for 25 rich OECD countries. We find that both taxation of corporate and personal income negatively influence economic growth. The correlation between corporate income taxation and economic growth is more robust, however.

Svensk statsförvaltning genomgår, precis som privat sektor, ständigt förändringar och omstruktureringar, drivna av olika samhällstrender, ledarskapsidéer och politiska styrfilosofier. Vid dessa förändringar ställs verksamheten inför vägval som på olika sätt kan påverka dess förmåga att leva upp till omgivningens krav och förväntningar. Samtidigt finns inte utrymme för risktagande, eftersom förvaltningens agerande och beslut kan vara avgörande för individers försörjning och framtid. Det ställer stora krav på dessa myndigheter, som balanserar ekonomimål, demokratimål och rättssäkerhetsmål. Denna bok avser att spegla olika organisatoriska dilemman och utmaningar som myndigheter i svensk och internationell statsförvaltning kan möta. Detta sker med utgångspunkt i en studie av Försäkringskassans enmyndighetsreform år 2005 och dess förändringsarbete under åren därefter. Bokens författare kommer från tre olika ämnesområden: företagsekonomi, nationalekonomi och statsvetenskap. Samtliga är knutna till Lunds universitet och till forskningsprogrammet ”Från många till en?” (2008-2012). Programmet finansierades av Försäkringskassan, men genomfördes självständigt. Med boken hoppas författarna kunna öka förståelsen – och intresset - för frågor om organisation, styrning och ledning i en statsförvaltning i förändring.

This study uses the Swedish register of prescribed drugs, merged with the Survey of Living Conditions (the ULF), to analyze the socioeconomic gradient in drug utilization. It finds a significant education gradient (but no income gradient) in individual drug utilization. Whereas the education gradient for men is quantitative in its orientation (education affects number of drugs used), the gradient for women is both quantitative and qualitative (education affects mean cost of drugs). For males, but not as clearly for females, the study finds that the education gradient is weaker for more health-related drugs but stronger for more expensive drugs. Our results indicate that the main reason for the education gradient in drug utilization is doctors’ behaviour rather than compliance with medication and affordability of drugs.

Försäkringskassan är en central del av den svenska välfärdsstaten och för¬medlar mycket stora penningsummor. De förändringar som myndigheten har genomfört under senare tid i form av ny organisation och ändrade besl¬utsregler har varit omdiskuterade. Kritiker har pekat på bristande effektivi¬tet, försenade utbetalningar och hjärtlös regeltillämpning. Ett antal vägval har gjorts för att söka hitta lösningar på problem som länge påtalats med bl.a. stora skillnader i regeltillämpning mellan olika delar av landet. I denna artikel studeras dessa vägval. Diskussionen tar sin utgångspunkt i ett antal motsatspar: enhetlighet-lokal anpassning; centralisering-decentralisering; specialisering-generalistideal; samt närhet-distans. Dessa motsatspar bely¬ses med exempel från de förändringar som har skett. Den allmänna slut¬satsen är att Försäkringskassans förändringsresa har varit stormig men att det har funnits ett betydande mått av konsistens sinsemellan i de gjorda vägvalen. The Swedish Social Insurance Agency is an important part of the Swedish welfare state. The Agency has recently made a number of major changes, such as establishing a new internal organization and reforming processes for decision making. Many of these changes have been controversial. Critics have complained that the Agency shows a lack of efficiency, has failed to make payments on time, and has been too harsh in its application of eligibility rules. The changes have put the agency at a number of crossroads, many of them recurring from earlier reforms, in dealing with problems such as regional differences in the application of rules. In this article, some of these choices are discussed. The discussion departs from four dichotomies: uniformity-local adaptation; centralization-decentralization; specialization-generalist approaches; and closeness-distance. These dichotomies are illustrated with examples from the agency. The general conclusion is that although the change process has taken a rocky road, there has been a great deal of internal consistency in the combination of measures taken.

Using longitudinal data, this paper investigates the penalty for excess weight in the Swedish labor market, distinguishing between the productivity and the discrimination hypotheses. We analyze employment, income, and sickness absence , using the latter as a direct measure of productivity. We find that excess weight women, but not men, experience a significant employment penalty. Both genders experience a significant income penalty for obesity. We conclude that the penalties are associated with lower productivity, primarily in terms of health. We find no evidence of discrimination.

We describe the policy consensus in the OECD publication Economic Surveys, by constructing a database that contains both quotations and a quantification of the perceived reform need for 23 OECD countries around 1985, 1995 and 2005. Using the database, we examine whether or not the policy recommendations given by the OECD require welfare state cutbacks. We also examine how reform need correlates with social expenditure and income inequality. The recommendations in OECD Economic Surveys describe a policy consensus based on competition, work incentives, monetary reform, fiscal discipline and labor market reform. Reforms in these areas do not necessarily require welfare state cutbacks. Quantitatively, we find a significant positive correlation between reform need and social expenditure only for the mid 1990s, and no significant correlations between reform need and inequality. We conclude that OECD countries with large welfare states have managed to implement reforms without substantial welfare state retrenchment. The policy recommendations in Economic Surveys imply a restructuring of the welfare state but not necessarily welfare state cutbacks.

Rapporten utvärderar och diskuterar situationen för Försäkringskassans försäkringsmedicinska verksamhet efter de senaste årens stora förändringsarbeten; reformen av sjukskrivningsprocessen och Försäkringskassans fusion. På basis av intervjuer med i första hand försäkringsmedicinska rådgivare, behandlar rapporten konsekvenserna för försäkringsmedicinska verksamheten i allmänhet men aktiviteterna i sjukförsäkringen i synnerhet.

This paper investigates the implications of an endogenous social work norm for the optimal welfare state program. Assuming that individual productivity is observable, the analysis finds that restrictions on program participation, implying a larger benefit to a smaller group of recipients, may be welfare improving. However, the effect of the norm is indeterminate. The disutility of non-compliance suggests a higher benefit; the endogeneity of the norm suggests a lower benefit. Assuming that individual productivity is not observable, the analysis finds that the social norm unambiguously contributes to increased program generosity. However, for sufficiently generous policies, the norm contributes to program retrenchment.

The thesis consists of an introductory chapter and three essays, considering sickness insurance, social norms and absence certification. The first essay, Group-Specific Social Norms and Economic Incentives in a General Welfare System, investigates the interaction between economic incentives and social influences in a general welfare system. We relate the results to sickness insurance. The model in Lindbeck, Nyberg & Weibull (1999) is modified by dividing the population into two groups, which are governed by group-specific social work norms. The behaviour of the two groups is studied in separate welfare systems as well as a shared system. We find that group affiliation matters for the generosity of the welfare policy, in terms of tax rate and transfer level, and for the share of transfer recipients. Furthermore, in a first-best scenario, it is observed that a restriction on the recipient share in exchange for a generous transfer may be optimal. Regarding the social norm, we find an ambiguous effect on the optimal welfare policy in a first-best scenario, whereas it implies a transfer increase in a second-best scenario. In the second essay, Sickness Absence Certification, we model sickness absence certification by assuming that the physician may certify absence for a worker without verifying that his ability to work is impaired due to sickness. Physicians with ?strict? as well as ?lax? sick-listing routines interact with workers who differ in their motivation for work. Depending on the physician type, or types, available and the expectations thereof, ?less motivated? workers are sick-listed regardless of working ability, while ?motivated? workers are sick-listed conditional on the observation of health-related ability impairment. We consider various policy instruments that the insurer may employ against a perceived misuse of the insurance and discuss their welfare implications, taking into account the match between worker and physician as well as the match between labour activity and working ability. The third essay, Occupational Physicians and General Practitioners ? Implications for Sickness Absence Certification, compares the certification practices of the occupational physician with those of the general practitioner. Whereas the latter adjusts his practices to the preferences of the worker, the former may have a restrictive attitude towards sick-listing, due to the client?s, that is the firm?s, influence. In contrast to the occupational physician's assessment of working ability, the general practitioner's assessment is imprecise, which implies an over-certification of sick-leave claims. Both ?less motivated? and ?motivated? workers prefer physicians with adjustable practices, resulting in different treatments of the workers regarding absence certification, provided that workers are able to attach expectations about treatment to individual physicians. However, ?motivated? workers also prefer correct information about ability, implying a risk of ?involuntary? sickness absence when general practitioners certify absence.