n/a

People may act differently in public environments due to actual reputation concerns, or due to the mere presence of others. Unlike previous studies on the influence of observability on prosocial behavior we control for the latter while manipulating the former, i.e. we control for implicit reputation concerns while manipulating explicit. We show that revealing decisions in public did not affect altruistic behavior, while it increased cooperation and made subjects less likely to make utilitarian judgments in sacrificial dilemmas (i.e., harming one to save many). Our findings are in line with theoretical models suggesting that people, at large, are averse to standing out in both positive and negative ways when it comes to altruistic giving. This "wallflower effect" does however not seem to extend to decisions on cooperation and moral judgments made in public.

Throughout the COVID-19 pandemic, media and policymakers openly speculated about the number of immune citizens needed to reach a herd immunity threshold. What are the effects of such numerical goals on the willingness to vaccinate? In a large representative sample (N = 1540) of unvaccinated Swedish citizens, we find that giving a low (60%) compared to a high (90%) threshold has direct effects on beliefs about reaching herd immunity and beliefs about how many others that will get vaccinated. Presenting the high threshold makes people believe that herd immunity is harder to reach (on average about half a step on a seven-point scale), compared to the low threshold. Yet at the same time, people also believe that a higher number of the population will get vaccinated (on average about 3.3% more of the population). Since these beliefs affect willingness to vaccinate in opposite directions, some individuals are encouraged and others discouraged depending on the threshold presented. Specifically, in mediation analysis, the high threshold indirectly increases vaccination willingness through the belief that many others will get vaccinated (B = 0.027, p = 0.003). At the same time, the high threshold also decreases vaccination willingness through the belief that the threshold goal is less attainable (B = -0.053, p < 0.001) compared to the low threshold condition. This has consequences for ongoing COVID-19 vaccination and future vaccination campaigns. One message may not fit all, as different groups can be encouraged or discouraged from vaccination.

When someone violates a social norm, others may think that some sanction would be appropriate. We examine how the experience of emotions like anger and disgust relate to the judged appropriateness of sanctions, in a pre-registered analysis of data from a large-scale study in 56 societies. Across the world, we find that individuals who experience anger and disgust over a norm violation are more likely to endorse confrontation, ostracism and, to a smaller extent, gossip. Moreover, we find that the experience of anger is consistently the strongest predictor of judgments of confrontation, compared to other emotions. Although the link between state-based emotions and judgments may seem universal, its strength varies across countries. Aligned with theoretical predictions, this link is stronger in societies, and among individuals, that place higher value on individual autonomy. Thus, autonomy values may increase the role that emotions play in guiding judgments of social sanctions.

Som vi visat har utvecklingen av metoder och strukturer för öppna prioriteringar i Sverige kommit långt. Många frågor återstår likväl. Under vårt arbete med denna bok har vi identifierat ett antal förbättringsområden och utmaningar som vi avslutningsvis vill lyfta fram. Det rör sig om vilka som ska delta i prioriteringarna, tydliggörande av värdegrunden, behov av bättre kunskap, baserad på både vetenskaplig metod och erfarenhet, och fortsatt utveckling av prioriteringsprocesser på olika nivåer och i olika sammanhang. Även om vi i Sverige skulle nå en god enighet kring principer och kriterier för prioriteringar så kommer vi alltid finna många olika sätt att praktiskt lösa specifika prioriteringsproblem.

The COVID-19 pandemic has affected all domains of human life, including the economic and social fabric of societies. One of the central strategies for managing public health throughout the pandemic has been through persuasive messaging and collective behaviour change. To help scholars better understand the social and moral psychology behind public health behaviour, we present a dataset comprising of 51,404 individuals from 69 countries. This dataset was collected for the International Collaboration on Social & Moral Psychology of COVID-19 project (ICSMP COVID-19). This social science survey invited participants around the world to complete a series of moral and psychological measures and public health attitudes about COVID-19 during an early phase of the COVID-19 pandemic (between April and June 2020). The survey included seven broad categories of questions: COVID-19 beliefs and compliance behaviours; identity and social attitudes; ideology; health and well-being; moral beliefs and motivation; personality traits; and demographic variables. We report both raw and cleaned data, along with all survey materials, data visualisations, and psychometric evaluations of key variables.

We explore how financial scarcity affects the strategy people choose to pay off their debts and the role of information avoidance in debt repayment. We conduct an online experiment in the United Kingdom (N = 1,000) in which people are endowed with multiple debts and given the task to pay off as many debts as possible during 15 rounds. We manipulate the level of financial scarcity by randomly assigning individuals to experience either a negative, a positive, or no financial shock during these 15 rounds. The results show that perceived financial scarcity is related to less optimal debt repayment. In conclusion, our findings suggest that perceived scarcity propels further scarcity due to poor debt management.

Introduction: Saving is a journey, beginning with the critical decision to initiate the process, take that pivotal first deposit step, and persistently commit to ongoing savings. However, a lot of saving plans fail already before any deposit is made, and even if the first deposit is made, long-run success of savings is far from guaranteed. In this study, we investigate both individual and saving-goal-specific determinants of successful savings.

Method: We use real-life savings data (N = 2,619 saving goals of 808 individuals) from a FinTech company in Sweden that helps individuals save for their goals. In addition, we collect a wide range of individual characteristics related to financial behavior: individuals' objective and subjective financial knowledge, self-control, and information avoidance.

Results and discussion: Our analysis uncovered distinctive patterns at different stages of the saving process. While objective financial knowledge didn't correlate with how much one saves, it was significantly related to the likelihood of making the first deposit. Furthermore, individuals with high self-control exhibited greater savings, though self-control was not related to the initiation of saving. Interestingly, subjective financial literacy and information avoidance showed no significant association with overall savings behavior. Additionally, our study indicated that the attainability of goals plays a crucial role in depositing funds, with more achievable goals having higher deposit likelihoods. Conversely, ambitious goals, despite their challenging nature, tended to attract more substantial savings. Our findings, grounded in real-life data, provide valuable insights into the intricate mechanisms influencing successful saving behaviors, shedding light on the complexities of financial decision-making and goal pursuit.

We investigate the antecedents of subjective financial well-being and general well-being during the ongoing COVID-19 pandemic. In an online survey conducted in the midst of COVID-19 pandemic with over 1000 Swedish participants we found that distrust in the government to cope with financial (but not healthcare) challenges of the pandemic was negatively related to the feeling of financial security. In a structural equation model, we also show that trust in government to deal with financial challenges of COVID-19 pandemic has a significant impact on general well-being through the mediating channel of financial well-being. In addition, trust in government to deal with healthcare challenges of COVID-19 pandemic has a significant direct impact on individuals’ general well-being. Our findings have important implications for public policy as they highlight the importance of citizens’ trust in well-functioning governmental institutions to help cope with not only healthcare, but also financial challenges of an ongoing pandemic.

Information ignorance refers to the act of deliberately avoiding, neglecting, or distorting information to uphold a positive self-image and protect our identity-based beliefs. We apply this framework to household finance and develop a concise 12-item questionnaire measuring individuals' receptiveness to financial information, or the lack thereof - the Financial Homo Ignorans (FHI) Scale. We conduct two studies with samples from the general population in Sweden (total N=2508) and show that the FHI scale has high reliability and distinct from other commonly used individual-difference measures in behavioral finance. We show that individual heterogeneity as assessed by the FHI scale explains a substantial variation in financial behaviors and financial well-being, also when controlling for demographics and financial literacy. These results unequivocally demonstrate the utility of the FHI scale as a valuable instrument for researchers and practitioners in comprehending and addressing the challenges posed by the omnipresence of financial information in today's world.

At the onset of the COVID-19 outbreak we conducted two surveys in the United Kingdom and Sweden (N=2021) regarding how people assess the near future economic situation within their household, nation, and the world. Together with psychological factors related to information processing we link these prospects to financial well-being. We find that, although generally very pessimistic, a substantial proportion of individuals believes that their households' economy will be doing substantially better than the national and global economy, suggesting a "financial better-than-average" effect. Furthermore, we find that the pessimism regarding future household economic situation and being financially ignorant are associated with decreased financial well-being, while the (inter)national economic situation is not. This study shows how contextual factors and personal aspects shape financial well-being during turbulent and stressful times.

Outcome editing refers to a set of mental rules that people apply when deciding whether to evaluate multiple outcomes jointly or separately, which subsequently affects choice. In a large-scale online survey (n = 2062) we investigate whether individuals use the same outcome editing rules for financial outcomes (e.g., a lottery win) and social outcomes (e.g., a party with friends). We also test the role of numeric ability in explaining outcome editing. Our results show that people’s preferences for combining or separating events depend on whether those events are in the financial or the social domain. Specifically, individuals were more likely to segregate social outcomes than monetary outcomes, except for when all outcomes were negative. Moreover, numeric ability was associated with preferences for outcome editing in the financial domain but not in the social domain. Our findings extend the understanding of the arithmetic operations underlying outcome editing and suggest that people rely more on calculations when making choices involving multiple financial outcomes and more on feelings when making choices involving social outcomes.

Data analysis workflows in many scientific domains have become increasingly complex and flexible. Here we assess the effect of this flexibility on the results of functional magnetic resonance imaging by asking 70 independent teams to analyse the same dataset, testing the same 9 ex-ante hypotheses(1). The flexibility of analytical approaches is exemplified by the fact that no two teams chose identical workflows to analyse the data. This flexibility resulted in sizeable variation in the results of hypothesis tests, even for teams whose statistical maps were highly correlated at intermediate stages of the analysis pipeline. Variation in reported results was related to several aspects of analysis methodology. Notably, a meta-analytical approach that aggregated information across teams yielded a significant consensus in activated regions. Furthermore, prediction markets of researchers in the field revealed an overestimation of the likelihood of significant findings, even by researchers with direct knowledge of the dataset(2-5). Our findings show that analytical flexibility can have substantial effects on scientific conclusions, and identify factors that may be related to variability in the analysis of functional magnetic resonance imaging. The results emphasize the importance of validating and sharing complex analysis workflows, and demonstrate the need for performing and reporting multiple analyses of the same data. Potential approaches that could be used to mitigate issues related to analytical variability are discussed. The results obtained by seventy different teams analysing the same functional magnetic resonance imaging dataset show substantial variation, highlighting the influence of analytical choices and the importance of sharing workflows publicly and performing multiple analyses.

In an anonymous 4-person economic game, participants contributed more money to a common project (i.e., cooperated) when required to decide quickly than when forced to delay their decision (Rand, Greene & Nowak, 2012), a pattern consistent with the social heuristics hypothesis proposed by Rand and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned to conditions and who met the protocol inclusion criteria (an intent-to-treat approach that included the 65.9% of participants in the time-pressure condition and 7.5% in the forced-delay condition who did not adhere to the time constraints), and we observed a difference in contributions of −0.37 percentage points compared with an 8.6 percentage point difference calculated from the original data. Analyzing the data as the original article did, including data only for participants who complied with the time constraints, the RRR observed a 10.37 percentage point difference in contributions compared with a 15.31 percentage point difference in the original study. In combination, the results of the intent-to-treat analysis and the compliant-only analysis are consistent with the presence of selection biases and the absence of a causal effect of time pressure on cooperation. 

Introduction: Airsonett Airshower (AA) is a novel non-pharmaceutical treatment for patients with perennial allergic asthma that uses a laminar airflow directed to the breathing zone of patients during sleep. It has been shown that AA treatment in addition to optimized standard therapy significantly increases asthma-related quality of life among adolescent asthmatics. However, the cost-effectiveness of AA treatment has not yet been assessed. As reimbursement decisions are increasingly guided by results from the cost-effectiveness analysis, such information is valuable for health-care policy-makers. Objective: The objective of this study was to estimate the cost-effectiveness of adding AA treatment with allergen-free air during night sleep to optimized standard therapy for adolescents with perennial allergic asthma compared with placebo. Materials and Methods: A probabilistic Markov model was developed to estimate costs and health outcomes over a 5-year period. Costs and effects are presented from a Swedish health-care perspective (QALYs). The main outcome of interest was cost per QALY gained. Results: The Airshower strategy resulted in a mean gain of 0.25 QALYs per patient, thus yielding a cost per QALY gained of under 35 000 as long as the cost of Airshower is below 8200. Conclusions: Adding AA treatment to optimized standard therapy for adolescents with perennial allergic asthma compared with placebo is generating additional QALYs at a reasonable cost. However, further studies taking more detailed resource use and events such as exacerbations into account would be needed to fully evaluate the cost-effectiveness of AA treatment. Please cite this paper as: Brodtkorb T-H, Zetterstrom O and Tinghog G. Cost-effectiveness of clean air administered to the breathing zone in allergic asthma.

The need for a national system to evaluate medical technologies other than pharmaceuticals is being considered. Several proposals advocate establishing a type of “Treatment Benefits Board”. To highlight problems and analyse the conditions for national assessments in this context, the National Board of Health and Welfare, the Medical Products Agency, the Swedish Council on Technology Assessment in Health Care (SBU), and the Dental and Pharmaceutical Benefits Agency (TLV) jointly appointed the Centre for Medical Technology Assessment (CMT) at Linköping University to conduct a preliminary study. The preliminary study should provide a foundation for the agencies to decide whether or not the issue needs to be investigated further.

The preliminary study aims to develop background information concerning how Sweden and other countries currently assess, prioritise, and implement decisions involving new nonpharmaceutical health technologies. The basic questions addressed are:

1. How can nonpharmaceutical technologies be defined and categorised for the purpose of setting parameters for an approval process?
2. How is the current process of assessment, prioritisation, and approval in Sweden structured, focusing on SBU, the Medical Products Agency, the National Board of Health and Welfare, and TLV?
3. How have other countries organised their systems for assessment, prioritisation, and approval of nonpharmaceutical technologies?

Within the framework of the project it was not possible to conduct detailed, onsite studies of the healthcare systems in other countries. Hence, we relied on descriptions of other countries’ systems as reported in scientific articles, reports, and official documents available from various organisations and other sources via the Internet. In some instances the information was complemented by interviewing key individuals. The same applies to the descriptions of Swedish agencies. Information concerning the prevalence of various technologies was collected from official reports/reviews and registry data. We present information from six countries where we found sufficient information to preliminarily answer the questions we formulated in advance. The countries are Australia, New Zealand, England, Spain, Italy, Canada, and the USA.

We draw the following conclusions from the preliminary study: It is relatively complicated to define nonpharmaceutical technologies and delineate the technologies that potentially could be subject to regulation. Our practical attempts to describe the technologies that SBU Alert has assessed show that:

surgical and medical interventions dominate, but a relatively high number of screening programmes have also been assessed;

• medical equipment and pharmaceuticals are the predominant input factors. Active implants and biological products are also relatively common. Assistive devices and dental products are seldom considered to be primary input factors;
• most technologies are used primarily for treatment purposes. Diagnostic technologies are also relatively common.

By removing pharmaceuticals from the equation and combining interventions and input factors, SBU Alert arrived at 18 different categories of health technologies that it assesses. The predominant combination is surgical intervention and biomedical equipment. This is followed by surgical intervention and insertion of active implants. In the report, we propose a way to define and classify technologies that we found to be appropriate for the purpose. This does not exclude pharmaceuticals. Rather, pharmaceuticals are included as one input factor among others.

Another aim was to produce background information describing how Sweden and other countries currently assess, prioritise, and approve new nonpharmaceutical technologies. We identified several key components that we believe are worth considering in designing a national system for assessing, prioritising, and approving new nonpharmaceutical health technologies. These components are:

• Organisational level – At what organisational level should the approval of nonpharmaceutical health technologies take place?
• Scope – Should an all-inclusive or selective approach be taken towards inclusion/selection of health technologies for assessment?
• Base package – Should there be a basic list showing what is financed with public funds, or is it sufficient to present only new decisions on the margin?
• Diversity of actors – Should a single actor, or many actors, be responsible for assessment, prioritisation, and decisions regarding financing?
• Fact producer – Who would be most appropriate to manage the factual information base?
• Transparency – How transparent should one be in presenting the decisionmaking process and its results?
• Political involvement – How politically independent should the decisions be?
• Budgetary responsibility – Should the unit that recommends or decides on approval have a budgetary responsibility?
• New and old – Should the decisions apply both to introducing new technology and phasing out old technology?
• Fundamental values – Should there be an explicit set of fundamental values for prioritisation, and how should it be formulated?
• Appeals – Should there be a mechanism to appeal decisions?

To summarise, we see a trend in other countries towards an increasing level of assessment and prioritisation in decisions regarding the introduction of nonpharmaceutical health technologies. Our preliminary impression is that nearly every system that we studied continues to develop and remains “a work in progress”. For instance, in Australia and New Zealand official inquiries are under way to suggest or present proposals for improvement.

Our studies of systems in different countries, although limited, indicate there is no perfect system to copy directly. The way in which the various systems are organised is somewhat related to how health care is organised in the respective countries and how many resources they have decided to dedicate to this purpose. The results from our preliminary study show, however, that several countries have more experience in “approving” nonpharmaceutical-based technologies than what we have in Sweden. The most interesting countries are England, New Zealand, Canada, and Australia. Spain could also be of interest. Hence, there is good reason to consider what might be the best way to analyse these countries’ systems in detail and complement this information with data from other nations that we were unable to include in the preliminary study, e.g. the Netherlands and Israel.

To more rigorously analyse other systems, if this project is continued, investigators should probably start from one or more models for a Swedish mechanism. To arrive at one or more tentative models in this context, the county councils should be involved in the project. The format could be a workshop that engages representatives from public agencies, county councils, and professional associations, where they jointly outline conceivable models that could then be analysed and discussed in light of the experiences of other nations.

Samhällets ekonomiska resurser är begränsade och därför finns det ingen möjlighet att offentligt finansiera alla vårdtjänster som har en positiv effekt. Prioritering och ransonering av hälso- och sjukvård är därmed ofrånkomlig. Ett sätt att göra detta på är att låta individen finansiera vissa produkter och tjänster direkt ur egen ficka. Gränsdragningen mellan det individuella och det offentliga ansvaret för finansiering av sjukvård är dock en komplex och politiskt känslig fråga, men den förtjänar likväl en öppen och konstruktiv diskussion. Vår utgångspunkt är att den svenska hälso- och sjukvården under överskådlig tid i huvudsak kommer att förbli offentligt finansierad, men vi konstaterar att en betydande andel av vården idag är privat finansierad. För att personer ska kunna ta ett eget ansvar för finansieringen krävs vissa förutsättningar. Det är därför viktigt att uppmärksamma var, när och hur det är rimligt att individen får ta ett eget ansvar för att finansiera sin vård, och när motsatsen gäller. Denna diskussion kan ta sin utgångspunkt i de etiska principer för prioriteringarsom gäller i Sverige: människovärdesprincipen, behovs-solidaritetsprincipen och kostnadseffektivitetsprincipen.

Det övergripande syftet med denna rapport är att analysera och diskutera grunden för egenansvar vid finansiering av vård. Syftet är också att presentera ett ramverk för att bedöma lämpligheten av egenfinansiering och applicera detta ramverk på läkemedelsområdet.

Ramverket består av sex kriterier/egenskaper kopplade till den specifika vårdinsatsen/produkten som bör vara delvis eller helt uppfyllda för att egenfinansiering ska bedömas som rimlig.

1. Den aktuella vårdinsatsen/produkten bör vara sådan att flertalet individer har god förmåga att värdera behov och kvalitet både före och efter användning.
2. Den aktuella vårdinsatsen/produkten bör främst utnyttjas av individer som kan betecknas som autonoma och reflekterande i sitt  beslutsfattande.
3. Den aktuella vårdinsatsen/produkten bör ge små posi tiva externa effekter.
4. Kostnaden för den aktuella vårdinsatsen/produkten bör vara överkomlig för de flesta som har behov av den.
5. Efterfrågan på den aktuella vårdinsatsen/produkten bör vara tillräckligt omfattande och regelbunden för att en privat marknad ska kunna uppstå.
6. Vårdinsatser/produkter som syftar till att förbättra prestationer, funktion eller utseende, utöver vad som anses normalt snarare än medicinsk nödvändigt, är mer lämpade för privat finansiering.

Sammanfattningsvis dras följande slutsatser i rapporten:

• Det finns idag en inte obetydlig mängd läkemedel som finansieras privat. Motiven för vad som finansieras privat eller offentligt är dock ofta oklara. Det finns också olikheter mellan landsting när det gäller finansiering av vårdtjänster och sjukvårdsprodukter.
• Det finns två huvudsakliga typer av egenansvar som kan beaktas vid prioriteringsbeslut: Ansvar för egen hälsa som fokuserar på individers tidigare hälsorelaterade livsstilsval. Ansvar för egen vård som fokuserar på vilka sjukvårdstjänster individer faktiskt klarar att ombesörja och finansiera själva.
• Ansvar för egen vård är den mest policyrelevanta formen av egenansvar eftersom det kan vara svårt att fastställa samband mellan beteende och ohälsa.
• Tillräcklig kunskap, individuell autonomi, externa effekter, tillräcklig efterfrågan, överkomligt pris och livsstilsförbättring är relevanta faktorer att beakta vid bedömning av egenfinansiering av läkemedel. Den form av egenansvar för finansiering som presenteras i rapporten 11 är i hög grad förenlig med intentionerna i människovärdesprincipen och behovs-solidaritetsprincipen.
• Det kan uppstå en konflikt mellan det presenterade ramverket och kostnadseffektivitetsprincipen när kostnadseffektiva läkemedel möjliggör egenansvar och därför med fördel kan finansieras privat trots en god kostnadseffektivitet.
• Mycket dyra läkemedel som inte är kostnadseffektiva är inte heller lämpliga för egenansvar. Samtidigt har samhället svårt att neka personer tillgång till verksamma läkemedel vid svår sjukdom. För att lösa detta dilemma bör man överväga möjligheten att samhället betalar för sådana läkemedel upp till den nivå där dessa bedöms kostnadseffektiva. Kostnaden därutöver skulle patienten kunna få möjlighet att finansiera själv. Sådana lösningar innebär antagligen en rad komplikationer som behöver utredas noga.
• För att egenansvar ska kunna tillämpas systematiskt och öppet vidprio riteringar behöver antagligen ett tidigare förslag från Socialstyrelsen till regeringen om att genomföra en översyn av den etiska plattformen aktualiseras på nytt.
• Det är angeläget att studera i vilken utsträckning privat finansiering leder till ökade skillnader i konsumtion och hälsa inom olika socioekonomiska grupper.
• Det finns inga perfekta lösningar för hur samhället ska dra gränsen för det offentliga åtagandet. Olika värden måste alltid balanseras mot varandra i syfte att uppnå en hälso- och sjukvård som är både rättvis och effektiv.

Det saknas tydliga principer i vården för att avgöra vad som ska finansieras privat respektive offentligt. Därför blir besluten ofta godtyckliga. Varför ska vi till exempel betala privat för glasögon medan hörapparater står det offentliga för?

Climate change is currently one of humanity's greatest threats. To help scholars understand the psychology of climate change, we conducted an online quasi-experimental survey on 59,508 participants from 63 countries (collected between July 2022 and July 2023). In a between-subjects design, we tested 11 interventions designed to promote climate change mitigation across four outcomes: climate change belief, support for climate policies, willingness to share information on social media, and performance on an effortful pro-environmental behavioural task. Participants also reported their demographic information (e.g., age, gender) and several other independent variables (e.g., political orientation, perceptions about the scientific consensus). In the no-intervention control group, we also measured important additional variables, such as environmentalist identity and trust in climate science. We report the collaboration procedure, study design, raw and cleaned data, all survey materials, relevant analysis scripts, and data visualisations. This dataset can be used to further the understanding of psychological, demographic, and national-level factors related to individual-level climate action and how these differ across countries.

Bakgrund

Under senare år har antalet nya fall av hudcancer kraftigt ökat. I Sverige har antalet dödsfall till följd av hudcancer ökat med 38 procent mellan åren 1997 och 2011. Denna utveckling leder inte enbart till ökat mänskligt lidande i samband med sjukdom utan också till en ökad ekonomisk börda för samhället. Det är därför av stor vikt att motverka denna oroande utveckling för att undvika en allt tyngre samhällsbörda till följd av hudcancer.

Syfte

I denna rapport presenteras förekomsten av olika hudcancerdiagnoser i Sverige 2011 samt samhällskostnaderna relaterat till dessa diagnoser. Dessutom redovisas en sammanställning av genomförda hälsoekonomiska utvärderingar av preventiva insatser mot hudcancer som finns publicerat internationellt.

Resultatet från studien utgör även ett viktigt kunskapsunderlag i uppföljningen och vid måluppfyllelsebedömningen av miljökvalitetsmåletSäker strålmiljö.

Resultat

De totala kostnaderna för hudcancer i Sverige år 2011 beräknas till 1,58 miljarder kronor. Direkta kostnader (dvs. sjukvårdskostnader) uppgick till 909 miljoner kronor (58 procent), medan indirekta kostnader(dvs. produktionsbortfall) uppgick till 671 miljoner kronor (42 procent). Malignt melanom är den enskilda hudcancerdiagnos som står för de största samhällskostnaderna, 830 miljoner kronor. Det är framförallt kostnaderna kopplade till produktionsbortfall vid dödsfall som bidrar till att malignt melanom är den samhällsekonomiskt mest belastande hudcancerformen. Icke melanom hudcancer står dock för de största sjukvårdskostnaderna, 348 miljoner kronor. Detta beror främst på att dessa cancertyper sammantaget är betydligt vanligare förekommande än malignt melanom. Kostnaderna som presenteras i rapporten visar på en ökning med 331 miljoner kronor jämfört med de kostnader som presenterades år 2005 i en rapport av Tinghög et al på uppdrag av Statens strålskyddsinstitut (SSI).

Konklusioner

Den sammantagna slutsatsen baserad på litteraturöversikten av hälsoekonomiska utvärderingar av preventiva metoder mot hudcancer är att det idag saknas studier relevanta för den svenska kontexten där kostnadseffe - tiviteten bedömts. Svårigheten att kunna genomföra randomiserade kontrollerade studier är en bidragande orsak till detta. Framöver bör initiativ för att beräkna kostnadseffektivi eten av preventiva åtgärder efterlysas.

Bullshit-sensitivity is the ability to distinguish pseudo-profound bullshit sentences (e.g. “Your movement transforms universal observations”) from genuinely profound sentences (e.g. “The person who never made a mistake never tried something new”). Although bullshit-sensitivity has been linked to other individual difference measures, it has not yet been shown to predict any actual behavior. We therefore conducted a survey study with over a thousand participants from a general sample of the Swedish population and assessed participants’ bullshit-receptivity (i.e. their perceived meaningfulness of seven bullshit sentences) and profoundness-receptivity (i.e. their perceived meaningfulness of seven genuinely profound sentences), and used these variables to predict two types of prosocial behavior (self-reported donations and a decision to volunteer for charity). Despite bullshit-receptivity and profoundness-receptivity being positively correlated with each other, logistic regression analyses showed that profoundness-receptivity had a positive association whereas bullshit-receptivity had a negative association with both types of prosocial behavior. These relations held up for the most part when controlling for potentially intermediating factors such as cognitive ability, time spent completing the survey, sex, age, level of education, and religiosity. The results suggest that people who are better at distinguishing the pseudo-profound from the actually profound are more prosocial.

This article investigates how donation behavior to charitable organizations and helping intentions toward begging European Union (EU)-migrants are related. This question was tested by analyzing survey responses from 1,050 participants sampled from the general Swedish population. Although the overall results suggested that donations to charitable organizations were positively related to helping intentions toward beggars, the results differed substantially as a function of whether the organization was perceived to focus its efforts on outgroup victims or on ingroup victims. Specifically, whereas donation behavior toward outgroup-focused organizations clearly predicted more helping intentions toward beggars (also when controlling for demographics, education, income, religiosity, and political inclination), donation behavior toward ingroup-focused organizations predicted slightly less helping intentions toward beggars. We conclude that the type of charitable organization a person donates to might tell us more about his or her values and preferences than merely whether or not he or she donates at all.

We study the effects of experimental manipulation of decision mode (rational "brain" vs. affective "heart") and individual difference in processing styles (intuition vs. deliberation) on prosocial behavior. In a survey experiment with a diverse sample of the Swedish population (n = 1,828), we elicited the individuals processing style and we experimentally manipulated reliance on affect or reason, regardless of subjects preferred mode. Prosocial behavior was measured across a series of commonly used and incentivized games (prisoners dilemma game, public goods game, trust game, dictator game). Our results show that prosocial behavior increased for the affective ("heart") decision mode. Further, individual differences in processing style did not predict prosocial behavior and did not interact with the experimental manipulation.

Both theory on motivational crowding and recent empirical evidence suggest that nudging may sometimes backfire and actually crowd out prosocial behavior, due to decreased intrinsic motivation and warm glow. In this study, we tested this claim by investigating the effects of three types of nudges (default nudge, social norm nudge, and moral nudge) on donations to charity in a preregistered online experiment (N = 1098). Furthermore, we manipulated the transparency of the nudges across conditions by explicitly informing subjects of the nudges that were used. Our results show no indication that nudges crowd out prosocial behavior; instead, all three nudges increased donations. The positive effects of the nudges were driven by the subjects who did not perceive the nudges as attempts to manipulate their behavior, while donations among subjects who felt that the nudges were manipulative remained unaffected. Subjects’ self-reported happiness with their choice also remained unaffected. Thus, we find no indication that nudges crowded out warm glow when acting altruistically. Generally, our results are good news for the proponents of nudges in public policy, since they suggest that concerns about unintended motivational crowding effects on prosocial behavior have been overstated.

How to balance the maximization of health and concerns for the worse off remains a challenge for health care decision makers when setting priorities. In regulatory guidelines these concerns are typically specified in terms of priority setting according to needs and priority setting according to cost-effectiveness. Still, it is often unclear when and why needs and cost-effectiveness diverge or overlap as guiding priority setting principles in practice. We conduct a comparative analysis of need and cost-effectiveness in the context of health care priority setting. Based on theories of distributive justice we specify three normative interpretations of need and explicate how these relate to the normative basis for cost-effectiveness analysis. Using priority-setting dilemmas we then move on to explicate when and why need and cost-effectiveness diverge as priority-setting principles. We find that: (i) although principles of need and cost-effectiveness may recommend the same allocation of resources the underlying reason for an allocation is different; (ii) while they both may give weight to patients who are worse off they do so in different ways and to different degree; and (iii) whereas cost-effectiveness clearly implies the aggregation of benefits across individuals principles of needs give no guidance with regard to if, and if so, how needs should be aggregated. Priority setting according to needs or cost-effectiveness does not necessarily recommend different allocations of resources. Thus, the normative conflict between them, often highlighted in practice, seems exaggerated. For health policy this is important knowledge because unclear conceptions may obstruct an informed public discussion. Moreover, if decision-makers are to properly account for both principles they need to recognize the inconsistencies as well as similarities between the two.

We test the effects of dual processing differences in both individual traits and decision states on risk taking. In an experiment with a large representative sample (N = 1,832), we vary whether risky choices are induced to be based on either emotion or reason, while simultaneously measuring individual decision-making traits. Our results show that decision-making traits are strong and robust determinants of risk taking: a more intuitive trait is associated with more risk taking, while a more deliberative trait is associated with less risk taking. Experimentally induced states, on the other hand, have no effect on risk taking. A test of state-trait interactions shows that the association between an intuitive trait and risk taking becomes weaker in the emotion-inducing state and in the loss domain. In contrast, the association between a deliberative trait and risk taking is stable across states. These findings highlight the importance of considering state-trait interactions when using dual processing theories to predict individual differences in risk taking.

Good self-control has been linked to adaptive outcomes such as better health, cohesive personal relationships, success in the workplace and at school, and less susceptibility to crime and addictions. In contrast, self-control failure is linked to maladaptive outcomes. Understanding the mechanisms by which self-control predicts behavior may assist in promoting better regulation and outcomes. A popular approach to understanding self-control is the strength or resource depletion model. Self-control is conceptualized as a limited resource that becomes depleted after a period of exertion resulting in self-control failure. The model has typically been tested using a sequential-task experimental paradigm, in which people completing an initial self-control task have reduced self-control capacity and poorer performance on a subsequent task, a state known as ego depletion. Although a meta-analysis of ego-depletion experiments found a medium-sized effect, subsequent meta-analyses have questioned the size and existence of the effect and identified instances of possible bias. The analyses served as a catalyst for the current Registered Replication Report of the ego-depletion effect. Multiple laboratories (k = 23, total N = 2,141) conducted replications of a standardized ego-depletion protocol based on a sequential-task paradigm by Sripada et al. Meta-analysis of the studies revealed that the size of the ego-depletion effect was small with 95% confidence intervals (CIs) that encompassed zero (d = 0.04, 95% CI [-0.07, 0.15]. We discuss implications of the findings for the ego-depletion effect and the resource depletion model of self-control.

When should nudging be deemed as permissible and when should it be deemed as intrusive to individuals’ freedom of choice? Should all types of nudges be judged the same? To date the debate concerning these issues has largely proceeded without much input from the general public. The main objective of this study is to elicit public views on the use of nudges in policy. In particular we investigate attitudes toward two broad categories of nudges that we label pro-self (i.e. focusing on private welfare) and pro-social (i.e. focusing on social welfare) nudges. In addition we explore how individual differences in thinking and feeling influence attitudes toward nudges. General population samples in Sweden and the United States (n=952) were presented with vignettes describing nudge-policies and rated acceptability and intrusiveness on freedom of choice. To test for individual differences, measures on cultural cognition and analytical thinking were included. Results show that the level of acceptance toward nudge-policies was generally high in both countries, but were slightly higher among Swedes than Americans. Somewhat paradoxically a majority of the respondents also perceived the presented nudge-policies as intrusive to freedom of choice. Nudge- polices classified as pro-social had a significantly lower acceptance rate compared to pro-self nudges (p<.0001). Individuals with a more individualistic worldview were less likely to perceive nudges as acceptable, while individuals more prone to analytical thinking were less likely to perceive nudges as intrusive to freedom of choice. To conclude, our findings suggest that the notion of “one-nudge- fits-all” is not tenable. Recognizing this is an important aspect both for successfully implementing nudges as well as nuancing nudge theory. 

Nudges are increasingly being proposed and used as a policy tool around the world. The success of nudges depends on public acceptance. However, several questions about what makes a nudge acceptable remain unanswered. In this paper, we examine whether policy alternatives to nudges influence the public's acceptance of these nudges: Do attitudes change when the nudge is presented alongside either a more paternalistic policy alternative (legislation) or a less paternalistic alternative (no behavioral intervention)? In two separate samples drawn from the Swedish general public, we find a very small effect of alternatives on the acceptability of various default nudges overall. Surprisingly, we find that when the alternative to the nudge is legislation, acceptance decreases and perceived intrusiveness increases (relative to conditions where the alternative is no regulation). An implication of this finding is that acceptance of nudges may not always automatically increase when nudges are explicitly compared to more paternalistic alternatives.

Compassion collapse is a phenomenon where feelings and helping behavior decrease as the number of needy increases. But what are the underlying mechanisms for compassion collapse? Previous research has attempted to pit two explanations: Limitations of the feeling system vs. motivated down-regulation of emotion, against each other. In this article, we critically reexamine a previous study comparing these two accounts published in 2011 and present new data that contest motivated down-regulation of emotion as the primary explanation for compassion collapse.

Inaccurate beliefs about procedural fairness often motivate people to act in self-serving and selfish manners. We investigate whether information about a level playing field might mitigate such behaviors. In a pre-registered behavioral experiment ( n = 4 4 4), using a competitive and real-effort task, we manipulate whether participants are informed about the fairness of a competition or not. Following the competition, participants (who either won or lost the competition) decided how to distribute earnings between themselves and their opponent. We show that informing participants about the fairness of the competition reduces selfish behavior among losers, while behavior among winners remains unaffected. Moreover, we show that losers who were not informed about the fairness of the competition incorrectly viewed it as having been unfairly stacked against them (i.e., believing that they encountered significantly more difficult tasks than their opponents). Our findings suggest that information about a level playing field reduces selfish behavior and is important for understanding when and why motivated reasoning about procedural fairness helps people uphold a positive self-image. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Due to diffusion of responsibility, majority voting may induce immoral and selfish behavior because voters are rarely solely responsible for the outcome. Across three behavioral experiments (two preregistered; n = 1983), we test this hypothesis in situations where there is a conflict between morality and material self-interest. Participants were randomly assigned to make decisions about extracting money from a charity either in an experimental referendum or individually. We find no evidence that voting induces immoral behavior. Neither do we find that people self-servingly distort their beliefs about their responsibility for the outcome when they vote. If anything, the results suggest that voting makes people less immoral.

Social drinking is common, but it is unclear how moderate levels of alcohol influence decision making. Most prior studies have focused on adverse long-term effects on cognitive and executive function in people with alcohol use disorders (AUD). Some studies have investigated the acute effects of alcohol on decision making in healthy people, but have predominantly used small samples and focused on a narrow selection of tasks related to personal decision making, e.g., delay or probability discounting. Here, we conducted a large (n = 264), preregistered randomized placebo-controlled study (RCT) using a parallel group design, to systematically assess the acute effects of alcohol on measures of decision making in both personal and social domains. We found a robust effect of a 0.6 g/kg dose of alcohol on both moral judgment and altruistic behavior, but no effects on several measures of risk taking or waiting impulsivity. These findings suggest that alcohol at low to moderate doses selectively moderates decision making in the social domain, and promotes utilitarian decisions over those dictated by rule-based ethical principles (deontological). This is consistent with existing theory that emphasizes the dual roles of shortsighted information processing and salient social cues in shaping decisions made under the influence of alcohol. A better understanding of these effects is important to understand altered social functioning during alcohol intoxication.

What is the effect of seemingly impressive verbal financial assertions that are presented as true and meaningful but are actually meaningless; that is, financial pseudo-profound bullshit? We develop and validate a novel measurement scale to assess consumers ability to detect and distinguish financial bullshit. We show that this financial bullshit scale captures a unique construct that is only moderately correlated with related constructs such as financial knowledge, numeracy, and cognitive reflection. Consumers particular vulnerable to financial bullshit are more likely to be young, male, have a higher income, and be overconfident with regards to their own financial knowledge. The ability to detect and distinguish financial bullshit also predicts financial well-being while being less predictive of consumers self-reported financial behavior, suggesting that susceptibility to financial bullshit is linked to affective rather than behavioral reactions. Our findings have implications for the understanding of how financial communication impacts consumer decision making and financial well-being.

We experimentally compare fast and slow decisions in a series of experiments on financial risk taking in three countries involving over 1700 subjects. To manipulate fast and slow decisions, subjects were randomly allocated to responding within 7 seconds (time pressure) or waiting for at least 7 or 20 seconds (time delay) before responding. To control for different effects of time pressure and time delay on measurement noise, we estimate separate parameters for noise and risk preferences within a random utility framework. We find that time pressure increases risk aversion for gains and risk taking for losses compared to time delay, implying that time pressure increases the reflection effect of Prospect Theory. The results for gains are weaker and less robust than the results for losses. We find no significant difference between time pressure and time delay for loss aversion (tested in only one of the experiments). Time delay also leads to less measurement noise than time pressure and unconstrained decisions, and appears to be an effective way of decreasing noise in experiments.

Pain is a highly salient and attention-demanding experience that motivates people to act. We investigated the effect of pain on decision making by delivering acute thermal pain to participants’ forearm while they made risky and intertemporal choices involving money. Participants (n = 107) were more risk seeking under pain than in a no-pain control condition when decisions involved gains but not when they involved equivalent losses. Pain also resulted in greater preference for immediate (smaller) over future (larger) monetary rewards. We interpret these results as a motivation to offset the aversive, pain-induced state, where monetary rewards become more appealing under pain than under no pain and when delivered sooner rather than later. Our findings add to the long-standing debate regarding the role of intuition and reflection in decision making.

Pleasant touch is thought to increase the release of oxytocin. Oxytocin, in turn, has been extensively studied with regards to its effects on trust and prosocial behavior, but results remain inconsistent. The purpose of this study was to investigate the effect of touch on economic decision making. Participants (n = 120) were stroked on their left arm using a soft brush (touch condition) or not at all (control condition; varied within subjects), while they performed a series of decision tasks assessing betrayal aversion (the Betrayal Aversion Elicitation Task), altruism (donating money to a charitable organization), and risk taking (the Balloon Analog Risk Task). We found no significant effect of touch on any of the outcome measures, neither within nor between subjects. Furthermore, effects were not moderated by gender or attachment. However, attachment avoidance had a significant effect on altruism in that those who were high in avoidance donated less money. Our findings contribute to the understanding of affective touch-and, by extension, oxytocin-in social behavior, and decision making by showing that touch does not directly influence performance in tasks involving risk and prosocial decisions. Specifically, our work casts further doubt on the validity of oxytocin research in humans.

We investigated the effect of ego depletion on risk taking. Specifically, we conducted three studies (total n= 1,716) to test the prediction that ego depletion results in decisions that are more strongly in line with prospect theory, i.e., that ego depletion reduces risk taking for gains, increases risk taking for losses, and increases loss aversion. Ego depletion was induced using two of the most common manipulations from previous literature: the letter e task (Studies 1 and 3) and the Stroop task (Study 2). Risk taking was measured using a series of standard, incentivized economic decision-making tasks assessing risk preferences in the gain domain, risk preferences in the loss domain, and loss aversion. None of the studies revealed a significant effect of ego depletion on risk taking. Our findings cast further doubts about the ability of ego-depletion manipulations to affect actual behavior in experimental settings.

The hypothesis that intuition promotes cooperation has attracted considerable attention. Although key results in this literature have failed to replicate in pre-registered studies, recent meta-analyses report an overall effect of intuition on cooperation. We address the question with a meta-analysis of 82 cooperation experiments, spanning four different types of intuition manipulations-time pressure, cognitive load, depletion, and induction-including 29,315 participants in total. We obtain a positive overall effect of intuition on cooperation, though substantially weaker than that reported in prior meta-analyses, and between studies the effect exhibits a high degree of systematic variation. We find that this overall effect depends exclusively on the inclusion of six experiments featuring emotion-induction manipulations, which prompt participants to rely on emotion over reason when making allocation decisions. Upon excluding from the total data set experiments featuring this class of manipulations, between-study variation in the meta-analysis is reduced substantially-and we observed no statistically discernable effect of intuition on cooperation. Overall, we fail to obtain compelling evidence for the intuitive cooperation hypothesis.

The hypothesis that intuition promotes cooperation has attracted considerable attention. We address the question with a meta-analysis of 82 cooperation experiments, spanning four different types of intuition manipulations—time pressure, cognitive load, depletion, and induction—including 29,087 participants in total. To our knowledge, this is the largest and most comprehensive data set to date. We obtain a positive overall effect of intuition on cooperation, though substantially weaker than that reported in prior meta-analyses, and between studies the effect exhibits a substantial degree of systematic variation. We find that this overall effect depends exclusively on the inclusion of six experiments featuring emotion-induction manipulations, which prompt participants to rely on emotion over reason when making allocation decisions. Upon excluding from the total data set experiments featuring this class of manipulations, between-study variation in the meta-analysis is reduced substantially—and we observed no statistically discernable effect of intuition on cooperation.

Do differences in worldview ideology hinder people from objectively interpreting the effect of immigration? In an experiment with Swedish adults (n = 1015), we investigate whether people display motivated reasoning when interpreting numerical information about the effects of refugee intake on crime rate. Our results show clear evidence of motivated reasoning along the lines of worldview ideology (i.e., whether people identify themselves primarily as nationally oriented or globally oriented). In scenarios where refugee intake was associated with higher crime rate, nationally oriented people were 18 percentage points more likely to make the correct assessment compared to globally oriented people. Likewise, in scenarios where refugee intake was associated with lower crime rate, nationally oriented people were 20 percentage points less likely to make the correct assessment compared to globally oriented people. Individuals with higher numeric ability were less likely to engage in motivated reasoning, suggesting that motivated reasoning more commonly is driven by feelings and emotional cues rather than deliberate analytical processes.

We studied the association of individual differences in objective financial knowledge (i.e. competence), subjective financial knowledge (i.e. confidence), numeric ability, and cognitive reflection on a broad set of financial behaviors and feelings towards financial matters. We used a large diverse sample (N = 2063) of the adult Swedish population. We found that both objective and subjective financial knowledge predicted frequent engagement in sound financial practices, while numeric ability and cognitive reflection could not be linked to the considered financial behaviors when controlling for other relevant cognitive abilities. In addition, both objective and subjective financial knowledge served as a buffer against financial anxiety, while we did not detect similar buffering effects of numeric ability and cognitive reflection. Subjective financial knowledge was found to be a stronger predictor of sound financial behavior and subjective wellbeing than objective financial knowledge. Women reported a lower level of subjective financial wellbeing even though they reported a more prudent financial behavior than men, when controlling for sociodemographics and cognitive abilities. Our findings help to understand heterogeneity in peoples propensity to engage in sound financial behaviors and have implications for important policy issues related to financial education.

Bounded ethicality refers to people’s limited capacity to consistently behave in line with their ethical standards. Here, we present results from a pre-registered, large-scale (N = 11,050) survey of researchers in Sweden, suggesting that researchers too are boundedly ethical. Specifically, researchers on average rated themselves as better than other researchers in their field at following good research practice, and rated researchers in their own field as better than researchers in other fields at following good research practice. These effects were stable across all academic fields, but strongest among researchers in the medical sciences. Taken together, our findings illustrate inflated self-righteous beliefs among researchers and research disciplines when it comes to research ethics, which may contribute to academic polarization and moral blindspots regarding one’s own and one’s colleagues’ use of questionable research practices.

The UK tariff for quality of life associated with the health states in the EQ-5D is probably not consistent with the preferences of Swedish health economists. This is worrying in view of the widespread use of the tariff values and the fact that health economists likely are better able than ordinary citizens to report their preferences for health states in a valid and reliable manner. We suggest this result is taken into account when the EQ-5D instrument is used, and that researchers should be cautious in using the UK (or any other) value sets. Our results also indicate that the variation across citizens in preferences for health may be a more complex issue than previously observed and deserves further study. An intriguing question for the future is to what extent health economists use methods and instruments that they themselves do not believe in.

The UK tariff for quality of life associated with the health states in the EQ-5D is probably not consistent with the preferences of Swedish health economists. This is worrying in view of the widespread use of the tariff values and the fact that health economists likely are better able than ordinary citizens to report their preferences for health states in a valid and reliable manner. We suggest this result is taken into account when the EQ-5D instrument is used, and that researchers should be cautious in using the UK (or any other) value sets. Our results also indicate that the variation across citizens in preferences for health may be a more complex issue than previously observed and deserves further study. An intriguing question for the future is to what extent health economists use methods and instruments that they themselves do not believe in.

In a seminal paper, Frederick et al. (J Consum Res 36:553-561, 2009) showed that peoples willingness to purchase a consumer good declined dramatically when opportunity costs were made more salient (Cohens d = 0.45-0.85). This finding suggests that people normally do not pay sufficient attention to opportunity costs and as a result make poorer and less efficient decisions, both in private and public domains. To critically assess the strength of opportunity cost neglect, we carried out a systematic review and a meta-analysis including published and non-published experimental work. In total, 39 experimental studies were included in the meta-analysis (N = 14,005). The analysis shows a robust significant effect (Cohens d = 0.22; p &lt; 0.001) of opportunity cost neglect across different domains, albeit the effect is considerably smaller than what was originally estimated by Frederick et al. (2009). Our findings highlight the importance of meta-analyses and replications of initial findings.