Maternal education and child health: Causal evidence from Denmark.

This study examines how maternal education shapes the life and health of their children. Causal effects are identified from a Danish school reform that increased minimum compulsory schooling from 7 to 9 years in 1972 and estimates are based on large administrative registers. We find that the reform as well as maternal education when instrumented by it, has significant, positive effects on mothers' age at first birth and maternal health. Nevertheless, maternal education has no systematic causal effects on child health, neither at birth, during childhood, or in adolescence. This null finding is robust to a wide range of model specifications.

The effect of complementary private health insurance on the use of health care services.

This study estimates the effect of complementary private health insurance (PHI) on the use of health care. The empirical analysis focuses on an institutional setting in which empirical findings are still limited; namely on PHI covering co-payment for treatments that are only partly financed by a universal health care system. The analysis is based on Danish data recently collected specifically for this purpose, which makes identification strategies assuming selection on observables only, and on both observables and unobservables also, both plausible and possible. We find evidence of a substantial positive and significant effect of complementary PHI on the use of prescription medicine and chiropractic care, a smaller but significant effect on dental care, weaker indications of effects for physiotherapy and general practice, and finally that the use of hospital-based outpatient care is largely unaffected. This implies that complementary PHI is generally not simply a marker of a higher propensity to use health care but induces additional use of some health care services over and above what would be used in the absence of such coverage.

Bargaining for health: a case study of a collective agreement-based health program for manual workers.

This paper examines the short- and medium-term effects of the PensionDanmark Health Scheme, the largest privately administered health program for workers in Denmark, which provides prevention and early management of work-related injuries. We use a difference-in-differences approach that exploits a natural variation in the program rollout across collective agreement areas in the construction sector and over time. The results show only little evidence of an effect on the prevention of injuries requiring medical attention in the first 3 years after the program was introduced. Despite this, we find evidence of significant positive effects on several labor market outcomes, suggesting that the program enables some work-injured individuals to maintain their work and earnings capacity. In view of its low costs, the program appears to be cost-effective overall.

Exploring the relationship between costs and quality: does the joint evaluation of costs and quality alter the ranking of Danish hospital departments?

OBJECTIVE: The purpose is to evaluate the relationship between costs and quality and to assess whether the joint evaluation of costs and quality affects the ranking of hospital departments relative to comparison based on costs alone. METHODS: Using patient level data for 3,754 patients in six vascular departments, we estimate fixed effect models for costs (linear) and quality (logistic). We consider two quality measures; mortality and wound complications. To assess whether the joint evaluation of costs and quality affects the ranking of departments, we construct joint confidence regions for each pair of departmental effects for costs and quality using a bootstrap method and rank departments according to their cost-effectiveness ratio. The findings are used to evaluate a theory of a U-shaped cost/quality relationship. RESULTS: The association between cost and quality differs depending on how quality is measured. Lower costs are associated with higher mortality, implying a cost/quality trade-off. In contrast, there is no clear association between costs and wound complications among vascular departments. CONCLUSIONS: Compared to benchmarking of departments based solely on their costs, we show that the ranking of departments may be altered considerably when quality is taken into account. Consequently, it is important to have a well-rounded view of departmental objectives when undertaking performance evaluation. The results for mortality may lend some support to the theory of a U-shaped cost/quality relationship. However, the results for wound complications do not support the theory of a U-shaped cost/quality relationship.

[Low income and number of contacts with general practice]. / Lavindkomst og antal kontakter med almen praksis.

INTRODUCTION: The purpose of this study was to examine whether there are differences in the use of general practice between citizens in low income groups and citizens with higher income after adjustment for social and health-related factors. MATERIAL AND METHODS: Registers from Statistics Denmark on adult citizens of Odense Municipality in 2005 were used. Income was measured as annual equivalent disposable income and adjustment for social and health-related personal characteristics was performed using Poisson regression. RESULTS: Poor adults with income below 73,000 DKK have 2-3 fewer contacts with general practice annually than those with an income of 73,000-146,000 DKK, while adults with an income above 292,000 DKK have the lowest utilization of general practice of any group. The difference between the poor and those with low income was reduced to 1.5 fewer contacts after adjustment for social and health-related characteristics and further to 1,1 when a sizeable unidentified socio-economic group was omitted. CONCLUSION: Poor adults have significantly fewer contacts with general practice than adults with low or middle income. This contrasts with results from earlier studies and may be an indication of underutilization of general practice. Other explanations may be that poor citizens enter the primary health sector through other channels or that the type and quality of contacts vary between income groups, that adjustment for health or other need indicators are insufficient. Furthermore, data shortcomings such as lack of information on non-taxed income and non-taxable assets may also serve as alternative explanations.

Do risk factors explain more of the social gradient in self-reported health when adjusting for baseline health?

BACKGROUND: It has often been debated the extent to which known risk factors explain socio-economic differences in health. While common in mortality studies, few studies of morbidity adjust for baseline health. In this study, we argue that there are sound reasons to do so, and examine whether a set of risk factors explain a larger part of social gradients in men and women's self-rated health (SRH) in Denmark when controlling for previous health. METHODS: We use interval regression models on longitudinal survey data from 1990 and 1995 separately for Danish male and female workers aged 18-59. RESULTS: Large social gradients are found in SRH for both men and women. The included risk factors (smoking, body mass index, high blood pressure and job satisfaction) reduce the educational gradient in SRH by 40% (based on highest versus no education), the wage gradient by 18% and leaves occupational gradients (based on no employment versus white collar workers) unaltered for men. For women, similar gradients are altered by 6 and 22 and 14% in cross-sectional models. Controlling for baseline health 5 years earlier, the risk factors reduce the education, occupation and wage gradients by 45, -15 and 17% for men and by 5, 25 and 15% for women. CONCLUSION: The findings suggest that common risk factors do not explain a larger fraction of social health inequalities in dynamic than in static models of self-reported health.