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Biomedical subjects

Unto Häkkinen

Publications and source records attributed to Unto Häkkinen.

At least 19 recordsLinked to original sources

Decomposition of health inequality by determinants and dimensions.

The study integrates two methodologies so that income-related inequality in general health can be decomposed into contributions from socio-demographic characteristics to each of the dimensions defining general health. It is found that these relative contributions vary substantially across dimensions. For policy purposes such information is valuable as it indicates at which population groups and at which aspects of health efforts to reduce inequalities in health should be targeted.

Adolescent↗

The effect of birth in secondary- or tertiary-level hospitals in Finland on mortality in very preterm infants: a birth-register study.

OBJECTIVE: Our goal was to test the hypothesis that the level of the delivery hospital affects 1-year mortality of very preterm infants in Finland. PATIENTS AND METHODS: This retrospective national medical birth-register study included 2291 very preterm infants (gestational age of < 32 weeks at birth or birth weight of < or = 1500 g) born in 14 level II (central) and 5 level III (university) hospitals in 2000-2003. The main outcome measures were adjusted total mortality (including stillbirths) and mortality of live-born infants until the age of 1 year. RESULTS: Both the total 1-year mortality and the 1-year mortality of live-born infants were higher in level II hospitals compared with level III hospitals. Total mortality was higher in very preterm infants who were not born during office hours. In theory, delivery of all very preterm infants in level III instead of level II hospitals translates into an annual prevention of 69 of the 170 total deaths and prevention of 18 of the 45 deaths of live-born infants. CONCLUSIONS: Resources in neonatal intensive care should be increased, especially during non-office hours, to have an equally distributed service through the 24-hour day. More efficient regionalization of very preterm deliveries may improve 1-year survival of very preterm infants in Finland.

Delivery, Obstetric↗

Health, schooling and lifestyle among young adults in Finland.

This was a longitudinal, general population study based on a Northern Finland 1966 Birth Cohort, using a structural equation approach to estimate the health production function and health input functions for four lifestyle variables (smoking, alcohol consumption, exercise and unhealthy diet) for males and females. In particular, we examined the productive and allocative effects of education on health. We used 15D, a generic measure of health-related quality of life, as a single index score measure but we also estimated models for some of its dimensions. Among the males, the important factors impacting on health were education and all the four lifestyle factors, as well as some exogenous variables at 31 years and variables describing parents' background, and health and behaviour at 14 years. An increase of five years in schooling increased the health score by 0.008, of which about 50% was due to direct effect and 50% due to indirect effects. Among the females, education does not impact on health, but health was affected by the use of alcohol, exercise and diet, but not by smoking. Our results indicate that policy options that increase education among men will increase their health indirectly via healthier lifestyles. However, since the total effect was rather modest and the direct effect insignificant, an increase of schooling is not a cost-effective way to increase health given the present high educational level of Finland. The young adults' and particularly women's internationally high educational status in Finland might be a reason why we find only a modest effect of schooling on health and the non-existence of such effects among women.

Adult↗

Choices and utilization in dental care: Public vs. private dental sectors, and the impact of a two-channel financed health care system.

We examine the determinants of the utilization of dentists' services among adults entitled to age-based subsidized dental care, using data from the Finnish Health Care Survey of 1996. We apply a three-part model to investigate the care-seeking decision, the choice of a private/public dentist, and the number of visits to each chosen dentist. Seeking care is found to be determined mainly by dentist's recall and mostly deterred by the expense of private care. Insufficient public availability and recall positively affect the choice of a private dentist, whereas income and dentist density increase the number of private visits. Need and socioeconomic variables are controlled for and are also important determinants. The findings suggest that lowering copayments and user fees and increasing the public supply of dental care, accompanied by an efficient recall system, might improve access to dental care and better steer the choice between sectors.

Adult↗

Reimbursing for the costs of teaching and research in Finnish hospitals: a stochastic frontier analysis.

In this study stochastic frontier cost function was used to estimate the teaching and research costs of Finnish hospitals. Predicted efficiency adjusted costs were calculated and compared to evaluate the current level of teaching and research reimbursement. The efficiency adjustment had significant impact on the marginal and average cost estimates of the teaching and research output. The results suggest that the average rate of teaching and research reimbursement should be approximately 14.6% of the total operating costs in university teaching hospitals. The main finding was that the university teaching hospitals were underfunded with respect to both research and teaching output.

Cost-Benefit Analysis↗

Comparing hospital cost efficiency between Norway and Finland.

In this study, cost efficiency in Finnish and Norwegian hospitals was compared using national discharge data and identical definitions for cost and output measures. Cross-sectional data on 47 Finnish and 51 Norwegian public hospitals in 1999 were used. Private, military and psychiatric hospitals were excluded. Data were collected from the National Discharge Registries. These were supplemented with cost information collected from hospitals' year-end accounts. The output data included admissions grouped according to diagnosis related groups (DRGs), outpatient visits, day care and inpatient days. Net hospital operating costs excluding capital costs were used as input. Nonparametric data envelopment analysis (DEA) was used in the calculation of cost efficiency. The results revealed marked differences in efficiency, in both within country and across country comparisons. According to preliminary results there was more variation in cost efficiency among Finnish hospitals, and the average level of cost efficiency was 17-25% lower in Norwegian hospitals. Although these preliminary results must be taken with caution, this study demonstrates the importance and potential benefits of integrating cost efficiency analysis into international comparisons of health care expenditure.

Cross-Sectional Studies↗

The association between quality of care and technical efficiency in long-term care.

OBJECTIVE: To analyse the association between quality of care and technical (productive) efficiency in institutional long-term care wards for the elderly. SETTING: One hundred and fourteen public health centre hospitals and residential homes in Finland. STUDY DESIGN: Wards were divided into two categories according to their rank in the quality distribution, considering 41 quality variables separately. The technical efficiency scores of the good- and poor-quality groups were compared using cross-sectional data. METHODS: Data envelopment analysis was used for calculating technical efficiency. The Mann-Whitney test and correlation coefficients were used to explore the association between quality and efficiency. RESULTS: The wards where quality indicators indicated less pro-active (passive) nursing practice and more dependent patients-for instance, in terms of very high prevalence of bedfast residents or very high prevalence of daily physical restraints-performed more efficiently than the comparison group. CONCLUSION: The results suggest that an association may exist between technical efficiency and unwanted dimensions of quality. Hence, the efficiency and quality of care are essential aspects of management and performance measurement in elderly care.

Aged↗

The impact of changes in Finland's health care system.

The most important reform in Finnish health care in the last decade occurred at the beginning of 1993 as part of a broader change to the entire state subsidy system. This reform reduced central government control and increased the freedom of the municipalities in the provision of health services. In addition, an unusually severe economic recession in the early 1990s affected Finnish health care. Currently, the most important economic decisions in the health care system are made by the 432 municipalities, which decide annually the amount of money to be devoted to health care as well as dividing resources in different sectors within the area of health. The changes in measures of productivity (based on activity-based measures in output) in the system are more closely associated with direct economic constraints (of municipalities) than with changes in financial incentive structures. Studies on equity in utilisation indicate that the Finnish health care system met the challenges of the 1991--1994 recession. Inequity in utilisation still prevails, however, and can be partly explained by the specific characteristics of the Finnish health care system. In future one needs to take more careful account of the rather unusual incentives that affect the behaviour of political decision-makers, providers and patients.

Financial Management↗

Measuring the productive efficiency and clinical quality of institutional long-term care for the elderly.

The authors consider the association between productive efficiency and clinical quality in institutional long-term care for the elderly. Cross-sectional data were collected from 122 wards in health-centre hospitals and residential homes in Finland in 2001. Productive efficiency was measured in terms of technical efficiency, which was defined as the unit's distance from the (best practice) production frontier. The analysis employed stochastic production frontier estimation, where technical inefficiency in the production function was specified to be a function of ward characteristics and clinical quality of care. Several quality indicators based on the Resident Assessment Instrument, such as prevalence of pressure ulcers and depression with no treatment, were used in the analysis. The results did not reveal systematic association between technical efficiency and clinical quality of care. However, the prevalence of pressure ulcers, indicating poor quality of care was associated with technical efficiency, a fact which highlights the importance of including quality measures in the assessment of efficiency in long-term care.

Aged↗

The cost efficiency and clinical quality of institutional long-term care for the elderly.

This study applied the stochastic frontier cost function with inefficiency effects to estimate the association between quality of care and cost efficiency in institutional long-term care wards for the elderly in Finland. We used several clinical quality indicators for indicating adverse care processes and outcomes, based on the Resident Assessment Instrument (RAI)/Minimum Data Set (MDS). Average cost inefficiency among the wards was 22%. We found an association between the clinical quality indicators and cost inefficiency. Higher prevalence of pressure ulcers was associated with higher costs, whereas the higher prevalence of use of depressants and hypnotics increased inefficiency.

Aged↗

Determinants of dental service utilization among adults--the case of Finland.

We examine the determinants of utilization of dentists' services and especially the role of supply factors in the decision-making processes of utilization, using data from the Finnish Health Care Survey of 1996. In a two-part model, care-seeking is modeled by a bivariate probit model taking into account dentist's recall, whereas the number of positive visits to the dentist is modeled by a zero-truncated negative binomial model. Recall turns out to be a central determinant of care-seeking and is significantly related to variables like income and unemployment. Socioeconomic variables are controlled for as well and are found to be important determinants.

Adult↗

Patient- and ward-level determinants of nursing time in nursing facilities.

OBJECTIVES: To explore the patient- and ward-level determinants of wage-adjusted nursing time in long-term care wards for the elderly with a view to improving efficiency of the use of labour resources. METHODS: The wage-adjusted nursing time given to patients was obtained from a time measurement study. Patient characteristics were based on the Minimum Data Set 2.0 of the Resident Assessment Instrument for nursing homes. Ordinary least-squares regression analysis and multilevel modelling were used to disentangle the effect of patient- and ward-level factors on nursing time. RESULTS: A significant difference in wage-adjusted nursing time between wards was detected, which was partly explained by characteristics of patients in wards. The combination of patients' physical functioning and cognition and the Resource Utilization Groups RUG-III/22 resource use classification explained 20-25% of patients' nursing time over a 24-hour period. Variables related to the operational environment of the ward did not explain differences in wage-adjusted nursing time once the patient profile of the ward had been controlled for. The results also showed notable unmeasured patient and ward level effects, inefficiency and randomness in the allocation of nursing time. CONCLUSIONS: By improving the allocation and use of labour resources, the substantial variation in nursing time between wards could be diminished. Managers should allocate their staff primarily according to patients' resource needs.

Benchmarking↗

Measuring inequality in self-reported health-discussion of a recently suggested approach using Finnish data.

Health surveys often include a general question on self-assessed health (SAH), usually measured on an ordinal scale with three to five response categories, from 'very poor' or 'poor' to 'very good' or 'excellent'. This paper assesses the scaling of responses on the SAH question. It compares alternative procedures designed to impose cardinality on the ordinal responses. These include OLS, ordered probit and interval regression approaches. The cardinal measures of health are used to compute and decompose concentration indices for income-related inequality in health. Results are provided using Finnish data on 15D and the SAH questions. Further evidence emerges for the internal validity of a method used in a pioneering study by van Doorslaer and Jones which was based on Canadian data on the McMaster Health Utility Index Mark III (HUI) and SAH. The study validates the conclusions drawn by van Doorslaer and Jones. It confirms that the interval regression approach is superior to OLS and ordered probit regression in assessing health inequality. However, regarding the choice of scaling instrument, it is concluded that the scaling of SAH categories and, consequently, the measured degree of inequality, are sensitive to characteristics of the chosen scaling instrument.

Female↗

Developing the formula for state subsidies for health care in Finland.

AIM: The aim was to generate a research-based proposal for a new subsidy formula for municipal healthcare services in Finland. METHODS: Small-area data on potential need variables, supply of and access to services, and age-, sex- and case-mix-standardised service utilisation per capita were used. Utilisation was regressed in order to identify need variables and the cost weights for the selected need variables were subsequently derived using various multilevel models and structural equation methods. RESULTS: The variables selected for the subsidy formula were as follows: age- and sex-standardised mortality (age under 65 years) and income for outpatient primary health services; age- and sex-standardised mortality (all ages) and index of overcrowded housing for elderly care and long-term inpatient care; index of disability pensions for those aged 15-55 years and migration for specialised non-psychiatric care; and index of living alone and income for psychiatric care. CONCLUSION: Decisions on the amount of state subsidies can be divided into three stages, of which the first two are mainly political and the third is based on the results of this study.

Adolescent↗

Case-mix adjustment and efficiency measurement.

AIMS: The importance of using valid case-mix systems in long-term care is addressed by comparing the predictive power of different case-mix models, and by applying them in the calculation of technical efficiency scores of care units. METHODS: To construct different case-mix models a statistical clustering technique (Automatic Interaction Detection) was used. Technical efficiency score were calculated using data envelopment analysis (DEA). RESULTS: The Resource Utilization Groups (RUG-III/22) classification explained 39% of resident specific cost, compared with 16% for a functional dependency scale in the Finnish patient information system HILMO. CONCLUSION: When assessing the economic performance of long-term care units it is important to pay attention to the predictive validity of the case-mix measure to be used. The choice of case-mix measure significantly affected how units were rated in efficiency.

Activities of Daily Living↗

Income-related inequality in the use of dental services in Finland.

The aim of this article is to measure and explain income-related inequalities in dentist utilisation. We apply concentration and horizontal inequity indices and the decomposition method to decompose observed inequalities into sources. The data are from the Finnish Health Care Survey of 1996. We examine three measures of utilisation: (a) the total number of visits; (b) the probability of visiting a dentist; and (c) the conditional number of positive visits for (i) visits to all dentists, (ii) those to public dentists and (iii) those to private dentists. The results for the whole sample show pro-poor inequities in all three measures of utilisation in public care, whereas in the first two measures there are pro-rich inequities nationwide and in private care. Among those entitled to age-based subsidised dental care, we find equality and equity in all three measures of utilisation nationwide. The two main factors related to pro-rich distributions of use are income and dentist's recall. To enhance equity in dental care across income groups, attention should be focused on supply factors and other incentives to encourage the poor to contact dentists more often.

Adolescent↗

Comparing the financial risk of bed-day and DRG based pricing types using parametric and simulation methods.

The extent of random financial risk involved in the Finnish bed-day and Diagnosis Related Groups (DRG) based hospital pricing systems were estimated and compared using parametric and simulation methods. DRG based payment schemes were found to provide significantly better protection against financial risk for municipalities, but municipality's size was the main determinant of financial risk. Small municipalities should use longer contracts between hospitals or form bigger purchaser-organisations for risk pooling. In addition, the current risk management system proved to be ineffective in decreasing the random variation in total costs.

Benchmarking↗