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  • 1.
    Andersson, David
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Brodtkorb, Thor-Henrik
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    DESCRIBING AND COMPARING HEALTH-RELATED QUALITY OF LIFE DERIVED FROM EQ-5D AND SF-6D IN A SWEDISH GENERAL POPULATION in VALUE IN HEALTH, vol 13, issue 7, pp A240-A2402010In: VALUE IN HEALTH, Blackwell Publishing Ltd , 2010, Vol. 13, no 7, A240-A240 p.Conference paper (Refereed)
    Abstract [en]

    n/a

  • 2.
    Bouwmeester, S
    et al.
    Erasmus University, The Netherlands.
    Verkoeijen, P. P. J. L.
    Erasmus University, The Netherlands.
    Aczel, B
    Eotvos Lorand University, Hungary.
    Barbosa, F
    University of Porto, Portugal.
    Bègue, L
    Universite Grenoble Alpes, France.
    Brañas-Garza, P
    Middlesex University, UK.
    Chmura, TGH
    University of Nottingham, UK.
    Cornelissen, G
    Pompeu Fabra University, Barcelona, Spain.
    Døssing, FS
    University of Copenhagen, Denmark.
    Espín, AM
    Middlesex University, UK.
    Evans, AM
    Tilburg University, The Netherlands.
    Ferreira-Santos, S
    University of Porto, Portugal.
    Fiedler, S
    Max Planck Institute, Germany.
    Flegr, J
    Charles University, Prague, Czech Republic.
    Ghaffari, M
    Max Planck Institute, Germany.
    Glöckner, A
    University of Hagen, Germany; Max Planck Institute, Germany.
    Goeschl, T
    University of Heidelberg, Germany.
    Guo, L
    University of California, USA.
    Hauser, OP
    Harvard University, USA.
    Hernan-Gonzalez, R
    University of Nottingham, UK.
    Herrero, A
    Universite Grenoble Alpes, France.
    Horne, Z
    University of Illinois, USA.
    Houdek, P
    University of Economics, Prague, Czech Republic.
    Johannesson, M
    Stockholm University, Sweden.
    Koppel, Lina
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Kujal, P
    Middlesex University, UK.
    Laine, T
    Universite Grenoble Alpes, France.
    Lohse, J
    University of Birmingham, UK.
    Martins, EC
    Maia University, Institute ISMI/CPUP, USA.
    Mauro, C
    Catholic University of Portugal, Portugal.
    Mischkowski, D
    University of Hagen, Germany.
    Mukherjee, S
    Indian Institute of Management Ahmedabad, India.
    Myrseth, KOR
    Trinity College Dublin, Ireland.
    Navarro-Martínez, D
    Pompeu Fabra University, Barcelona, Spain.
    Neal, TMS
    Arizona State University, USA.
    Novakova, J
    Charles University, Prague, Czech Republic.
    Pagà, R
    Pompeu Fabra University, Barcelona, Spain.
    Paiva, TO
    University of Porto, Portugal.
    Palfi, B
    Eotvos Lorand University, Hungary.
    Piovesan, M
    University of Copenhagen, Denmark.
    Rahal, RM
    Max Planck Institute, Germany.
    Salomon, E
    University of Illinois, USA.
    Srinivasan, N
    University of Allahabad, India.
    Srivastava, A
    University of Allahabad, India.
    Szaszi, B
    Eotvos Lorand University, Hungary.
    Szollosi, A
    Eotvos Lorand University, Hungary.
    Thor, K Ø
    University of Copenhagen, Denmark.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Trueblood, JS
    Vanderbilt University, USA.
    van Bavel, JJ
    New York University, USA.
    van ‘t Veer, A. E.
    Leiden University, The Netherlands.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decision Research, Eugene, OR, USA.
    Warner, M
    Arizona State University, USA.
    Wengström, E
    Lund University, Sweden.
    Wills, J
    New York University, USA.
    Wollbrant, CE
    University of Gothenburg, Sweden; NTNU Business School, Norway.
    Registered Replication Report: Rand, Greene, and Nowak (2012): Multilab direct replication of: Study 7 from Rand, D. G., Greene, J. D., & Nowak, M. A. (2012) Spontaneous giving and calculated greed. Nature, 489, 427–430.2017In: Perspectives on Psychological Science, ISSN 1745-6916, E-ISSN 1745-6924, Vol. 12, no 3, 527-542 p.Article in journal (Refereed)
    Abstract [en]

    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. 

  • 3.
    Brodtkorb, Thor-Henrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Zetterström, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Cost-effectiveness of clean air administered to the breathing zone in allergic asthma2010In: CLINICAL RESPIRATORY JOURNAL, ISSN 1752-6981, Vol. 4, no 2, 104-110 p.Article in journal (Refereed)
    Abstract [en]

    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.

  • 4.
    Carlsson, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Brodtkorb, Thor-Henrik
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Heintz, Emelie
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Nationellt system för utvärdering, prioritering och införandebeslut av icke-farmakologiska sjukvårdsteknologier: en förstudie2010Report (Other academic)
    Abstract [en]

    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.

  • 5.
    Carlsson, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Läkemedel: när är det rimligt att betala själv?2013 (ed. 1)Book (Other academic)
    Abstract [sv]

    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.
  • 6.
    Carlsson, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Vilken vård bör vi betala själva?2013In: Svenska Dagbladet, ISSN 1101-2412Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    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?

  • 7.
    Eriksson, Therese
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Letter: Societal Cost of Skin Cancer in Sweden in 20112015In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 95, no 3, 347-348 p.Article in journal (Other academic)
  • 8.
    Eriksson, Thérèse
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Samhällskostnader för hudcancer 20112014Report (Other academic)
    Abstract [sv]

    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.

  • 9.
    Hagger, Martin S.
    et al.
    Curtin University, Australia.
    Chatzisarantis, Nikos L. D.
    Curtin University, Australia.
    Tinghög, Gustav (Contributor)
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    A multilab preregistered replication of the ego-depletion effect2016In: Perspectives on Psychological Science, ISSN 1745-6916, E-ISSN 1745-6924, Vol. 11, no 4, 546-573 p.Article in journal (Refereed)
    Abstract [en]

    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. 

  • 10.
    Kirchler, Michael
    et al.
    University of Innsbruck, Austria; University of Gothenburg, Sweden.
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Bonn, Caroline
    University of Innsbruck, Austria.
    Johannesson, Magnus
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Stockholm School Econ, Sweden.
    Sorensen, Erik O.
    NHH Norwegian School Econ, Norway.
    Stefan, Matthias
    University of Innsbruck, Austria.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Research, OR 97401 USA.
    The effect of fast and slow decisions on risk taking2017In: Journal of Risk and Uncertainty, ISSN 0895-5646, E-ISSN 1573-0476, Vol. 54, no 1, 37-59 p.Article in journal (Refereed)
    Abstract [en]

    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.

  • 11.
    Koppel, Lina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Andersson, David
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Morrison, India
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Posadzy, Kinga
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Västfjäll, Daniel
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decision Research, Eugene, OR, USA.
    Tinghög, Gustav
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences.
    The effect of acute pain on risky and intertemporal choice2017In: Experimental Economics, ISSN 1386-4157, E-ISSN 1573-6938, 1-16 p.Article in journal (Refereed)
    Abstract [en]

    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.

  • 12.
    Meunier, Andreas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Posadzy, Kinga
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Arts and Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Risk preferences and attitudes to surgery in decision making2017In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 5, 466-471 p.Article in journal (Refereed)
    Abstract [en]

    Background and purpose — There is increasing evidence that several commonly performed surgical procedures provide little advantage over nonoperative treatment, suggesting that doctors may sometimes be inappropriately optimistic about surgical ben- efit when suggesting treatment for individual patients. We investi- gated whether attitudes to risk influenced the choice of operative treatment and nonoperative treatment.

    Methods — 946 Swedish orthopedic surgeons were invited to participate in an online survey. A radiograph of a 4-fragment proximal humeral fracture was presented together with 5 differ- ent patient characteristics, and the surgeons could choose between 3 different operative treatments and 1 nonoperative treatment. This was followed by an economic risk-preference test, and then by an instrument designed to measure 6 attitudes to surgery that are thought to be hazardous. We then investigated if choice of non-operative treatment was associated with risk aversion, and thereafter with the other variables, by regression analysis.

    Results — 388 surgeons responded. Nonoperative treatment for all cases was suggested by 64 of them. There was no significant association between risk aversion and tendency to avoid surgery. However, there was a statistically significant association between suggesting to operate at least 1 of the cases and a “macho” atti- tude to surgery or resignation regarding the chances of influenc- ing the outcome of surgery. Choosing nonoperative treatment for all cases was associated with long experience as a surgeon.

    Interpretation — The discrepancy between available evidence for surgery and clinical practice does not appear to be related to risk preference, but relates to hazardous attitudes. It appears that choosing nonoperative treatment requires experience and a feel- ing that one can make a difference (i.e. a low score for resigna- tion). There is a need for better awareness of available evidence for surgical indications. 

  • 13.
    Mooney, Gavin
    et al.
    University of Southern Denmark.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, The Institute of Technology.
    Kalkan, Almina
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    The Need for a New Paradigm in Scandinavian Health Economics2012In: Nordic Journal of Health Economics, ISSN 1892-9710, Vol. 1, no 2, 119-132 p.Article in journal (Refereed)
    Abstract [en]

    This paper argues that the discipline of health economics has lost its way due to its persistent focus on individualistic and consequential values. The paper suggests how this might be remedied in both theory and practice. It proposes a new paradigm for health economics, which focuses on communitarian values. This new paradigm is discussed in the context of the Scandinavian welfare model.

  • 14.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Omnell Persson, Marie
    Department of Nephrology and Transplantation, Skåne University Hospital (Malmö), Lund University, Malmö, Sweden.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Priority setting in kidney transplantation: A qualitative study evaluating Swedish practices2013In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 2, 206-215 p.Article in journal (Refereed)
    Abstract [en]

    Background: Kidney transplantation is the established treatment of choice for end-stage renal disease; it increases survival, and quality of life, while being more cost effective than dialysis. It is, however, limited by the scarcity of kidneys. The aim of this paper is to investigate the fairness of the priority setting process underpinning Swedish kidney transplantation in reference to the Accountability for Reasonableness (A4R) framework. To achieve this, two significant stages of the process influencing access to transplantation are examined: assessment for transplant candidacy, and allocation of kidneys from deceased donors.

    Methods: Semi-structured interviews were the main source of data collection. Fifteen Interviewees included transplant surgeons, nephrologists, and transplant coordinators representing centers nationwide. Thematic analysis was used to analyze interviews, with the Accountability for Reasonableness framework serving as an analytical lens.

    Results: Decision-making both in the assessment and allocation stages are based on clusters of factors that belong to one of three levels: patient, professional, and the institutional levels. The factors appeal to values such as maximizing benefit, priority to the worst off, and equal treatment which are traded off.

    Discussion and Conclusions: The factors described in this paper and the values on which they rest on the most part satisfy the relevance condition of the accountability for reasonableness framework. There are however two potential sources for unequal treatment which we have identified: clinical judgment and institutional policies relating both to assessment and allocation. The appeals mechanisms are well developed and supported nationally which help to offset differences between centers. There is room for improvement in the areas of publicity and enforcement. The development of explicit national guidelines for assessing transplant candidacy and the creation of a central kidney allocation system would contribute to standardize practices across centers; and in the process help to better meet the conditions of fairness in reference to the A4R. The benefits of these policy proposals in the Swedish kidney transplant system merit serious consideration.

  • 15.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Department of Culture and Communication, Arts and Humanities. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Health Sciences.
    Risk för orättvis prioritering av patienter vid njurtransplantation: En enda väntelista bör införas, visar studie av svensk praxis2014In: Läkartidningen, ISSN 0023-7205, Vol. 111, no 37Article in journal (Refereed)
    Abstract [en]

    In order to investigate the fairness of the priority setting process underpinning Swedish kidney transplantation in reference to the Accountability for Reasonableness (A4R) framework, 15 interviews with transplant surgeons, nephrologists, and coordinators were carried out. The factors described by interviewees and the values they rest on satisfy the relevance criterion of the A4R. Two potential sources for unfair inequalities were identified, namely the use of clinical judge­ments and varying institutional policies among dif­ferent centres. It is recommended that factors and values used in the priority process are made more public. Sweden should also consider a national, centralised system for allocation of kidneys and not rely on present day local allocation.

  • 16.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Tinghög, Petter
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Attitudes towards priority-setting and rationing in healthcare - an exploratory survey of Swedish medical students2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 2, 122-130 p.Article in journal (Refereed)
    Abstract [en]

    Background: Healthcare priority-setting is inextricably linked to the challenge of providing publicly funded healthcare within a limited budget, which may result in difficult and potentially controversial rationing decisions. Despite priority-settings increasing prominence in policy and academic discussion, it is still unclear what the level of understanding and acceptance of priority-setting is at different levels of health care. Aims: The aim of this study is threefold. First we wish to explore the level of familiarity with different aspects of priority-setting among graduating medical students. Secondly, to gauge their acceptance of both established and proposed Swedish priority-setting principles. Finally to elucidate their attitudes towards healthcare rationing and the role of different actors in decision making, with a particular interest in comparing the attitudes of medical students with data from the literature examining the attitudes among primary care patients in Sweden. Methods: A cross-sectional survey containing 14 multiple choice items about priority-setting in healthcare was distributed to the graduating medical class at Linkoping University. The response rate was 92% (43/47). Results: Less than half of respondents have encountered the notion of open priority-setting, and the majority believed it to be somewhat or very unclear. There is a high degree of awareness and agreement with the established ethical principles for priority-setting in Swedish health care; however respondents are inconsistent in their application of the cost-effectiveness principle. A larger proportion of respondents were more favourable to physicians and other health personnel being responsible for rationing decisions as opposed to politicians. Conclusions: Future discussion about priority-setting in medical education should be contextualized within an explicit and open process. There is a need to adequately clarify the role of the cost-effectiveness principle in priority-setting. Medical students seem to acknowledge the need for rationing in healthcare to a greater extent when compared with previous results from Swedish primary care patients.

  • 17.
    Omar, Faisal
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Tinghög, Gustav
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Tinghög, Petter
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medicine and Health Sciences, Health and Society.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Diffusion of priority setting ethical principles in Swedish medical education (oral presentation)2008In: The 7th International Conference on Priorities in Health Care,2008, 2008Conference paper (Other academic)
    Abstract [en]

          

  • 18.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Incentivizing deceased organ donation: A Swedish priority-setting perspective.2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 2, 156-163 p.Article in journal (Refereed)
    Abstract [en]

    AIMS: The established deceased organ donation models in many countries, relying chiefly on altruism, have failed to motivate a sufficient number of donors. As a consequence organs that could save lives are routinely missed leading to a growing gap between demand and supply. The aim of this paper is twofold; firstly to develop a proposal for compensated deceased organ donation that could potentially address the organ shortage; secondly to examine the compatibility of the proposal with the ethical values of the Swedish healthcare system.

    METHODS: The proposal for compensating deceased donation is grounded in behavioural agency theory and combines extrinsic, intrinsic and signalling incentives in order to increase prosocial behaviour. Furthermore the compatibility of our proposal with the values of the Swedish healthcare system is evaluated in reference to the principles of human dignity, needs and solidarity, and cost effectiveness.

    RESULTS: Extrinsic incentives in the form of a €5,000 compensation towards funeral expenses paid to the estate of the deceased or family is proposed. Intrinsic and signalling incentives are incorporated by allowing all or part of the compensation to be diverted as a donation to a reputable charity. The decision for organ donation must not be against the explicit will of the donor.

    CONCLUSIONS: We find that our proposal for compensated deceased donation is compatible with the values of the Swedish healthcare system, and therefore merits serious consideration. It is however important to acknowledge issues relating to coercion, commodification and loss of public trust and the ethical challenges that they might pose.

  • 19.
    Omar, Faisal
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences.
    Tinghög, Gustav
    Linköping University. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Health and Society.
    Incentivizing organ donation: a Swedish priority setting perspective (oral presentation)2010Conference paper (Refereed)
  • 20.
    Omar, Faisal
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tinghög, Petter
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Welin, Stellan
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Transplant tourism and compensated kidney donation: A survey of opinions amongst Swedish medical students2010In: International Journal of Health Promotion & Education, ISSN 1463-5240, Vol. 48, no 4, 106-112 p.Article in journal (Refereed)
    Abstract [en]

    Objective: Transplant tourism and proposals for regulated compensated donation are reactions to the global scarcity in kidneys. These areas raise unique ethical challenges in medical education and clinical practice. We aimed to elucidate the opinions of soon-to-be physicians on transplant tourism, and compensated donation. We investigated how these opinions are formed, if they are interrelated, and their impact on encounters with patients.

    Design and Methods: a 14 item survey was developed using cognitive interviewing techniques, and distributed to the graduating class at Linköping Medical University. Spearman's correlation coefficient and Pearson's chi-square test were employed to investigate significant associations.

    Results: The response rate was 43/47 (92%). The majority were strongly (64%), or somewhat (29%) against transplant tourism. Those with strong negative positions on transplant tourism were significantly (p<0.05) more likely to dissuade patients from pursuing it. More students expressed support for regulated compensation from a clinical perspective (34%) as compared with support from an ethical perspective (15%).

    Conclusions: The opinions of young physicians on transplant tourism are a significant indicator for their clinical approach. Young physicians balance competing ethical responsibilities such as respect for autonomy against concerns for kidney vendors in the developing world. Clinical and policy scenarios, similar to those used in this survey are useful tools for students to explore challenging ethical issues within their medical education, to provide appropriate guidance for patients and empower them through health education.

     

  • 21.
    Sandman, Lars
    et al.
    Högskolan Borås.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Att tillämpa den etiska plattformen vid ransonering: Fördjupad vägledning och konsekvensanalys2011Report (Other academic)
    Abstract [en]

    The ethics platform for prioritisation in the health care sector is well established in the Swedish context and is applied in the national model for prioritisation, largely when health services engage in prioritisation processes at different levels. Nevertheless, the platform and model are open to interpretation regarding the different appraisals and considerations that must take place in conjunction with prioritisation. These appraisals and considerations should receive even greater attention when the prioritisation process must be used for rationing, i.e. when the publicly financed health system decides to stop offering certain services. This report aims to present an interpretation of how the ethics platform can be understood when we focus on rationing situations. It involves: establishing several criteria based on the ethics platform’s explicit statements, the interpretations that appear in underlying policy documents, and a general discussion on ethics related to these. We should emphasise that this is the authors’ interpretation of how the ethics platform should be understood and the considerations that should be taken in conjunction with rationing situations. Hopefully, these concur with interpretations from other perspectives.

    The report begins by exploring the rationing concept, followed by a review of the three principles in the ethics platform and the relevant sections in the underlying policy document that forms the foundation for interpreting the remainder of the report. The main chapter formulates criteria to be considered in conjunction with rationing (and to a large extent prioritisation in general) in relation to the three principles of the platform. The considerations not allowed by the human dignity principle are formulated into several framework criteria. Thereafter, we use the needs and solidarity principle to introduce the section to determine what can be meant by care needs and care interventions of various types, how to determine the scope of a care need, and how to weigh a care intervention. Based on a distinction between life-length (or expectancy) needs and quality-of-life needs, several criteria for rationing are then formulated.

    The main chapter concludes with a discussion of the cost effectiveness principle. This section is introduced with an interpretation of the effects of intervening and how we should view costs and cost effectiveness. Again, several rationing criteria are formulated based on the cost-effectiveness principle. In the final chapter (before the discussion chapter), the formulated rationing criteria are compiled into a checklist of steps concerning what rationing should take into account in considering the values and norms of the ethics platform.

     

    The discussion chapter addresses several contradictions or problems involving the current ethics platform, which may require further clarification or changes. The appendix presents a brief summary of an ethics analysis concerning phasing out and rationing at Sahlgrenska University hospital, where the checklist is used.

  • 22.
    Strömbäck, Camilla
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Lind, Thérèse
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Department of Management and Engineering, Economics.
    Skagerlund, Kenny
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Decision Research .
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Arts and Sciences.
    Does self-control predict financial behavior and financial well-being?2017In: Journal of Behavioral and Experimental Finance, ISSN 2214-6350, E-ISSN 2214-6369, ISSN 2214-6350, Vol. 14, 30-38 p.Article in journal (Refereed)
    Abstract [en]

    To improve our understanding of how people make financial decisions, it is important to investigate what psychological characteristics influence individuals’ positive financial behavior and financial well-being. In this study, we explore the effect of individual differences in self-control and other non-cognitive factors on financial behavior and financial well-being. A survey containing measures of financial behavior, subjective financial well-being, self-control, optimism, deliberative thinking and demographic variables was sent to a representative sample (n=2063)" role="presentation" style="box-sizing: border-box; display: inline-block; line-height: normal; font-size: 14.399999618530273px; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; color: rgb(80, 80, 80); font-family: Arial, Helvetica, 'Lucida Sans Unicode', 'Microsoft Sans Serif', 'Segoe UI Symbol', STIXGeneral, 'Cambria Math', 'Arial Unicode MS', sans-serif; position: relative;"> of the Swedish population. Our findings extend the application of the behavioral lifecycle hypothesis beyond savings behavior, to include general financial behavior. People with good self-control are more likely to save money from every pay-check, have better general financial behavior, feel less anxious about financial matters, and feel more secure in their current and future financial situation.

  • 23.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, The Institute of Technology.
    Are Individuals Luck Egalitarians? – An experiment on the influence of brute and option luck on social preferences2012Conference paper (Other academic)
    Abstract [en]

    Background / Objectives

    According to luck egalitarianism, inequalities should be deemed fair as long as they follow from individuals’ deliberate and fully informed choices, i.e. option luck – while inequalities should be deemed unfair if they follow from choices over which the individual has no control, i.e. brute luck. This study investigates if individuals’ fairness preferences correspond with the luck egalitarian fairness position. More specifically, in a laboratory experiment we test how individuals choose to redistribute gains and losses that stem from option luck compared to brute luck.

    Methods / Design

    A two-stage experimental design was employed. In total, 125 subjects were randomly assigned to either the brute luck or option luck treatment. Treatments were identical except for how monetary compensation for participation in the experiment was settled in stage one. In the option luck treatment, subjects were given the option to chose between a safe option (50 Sek) and a risky option (a 50/50 gamble between 0 SEK and 150 SEK) for how they would be compensated for participating in the experiment. In the brute luck treatment no such choice was given, instead  all subjects were compensated based on outcome of the risky option. In the second stage, before winners and losers of the gamble were revealed, subjects were asked to distribute additional endowments (100 SEK) in an anonymous dictator game using the strategy method, i.e. making decisions contingent on the recipient losing or wining in the gamble.

    Results / Findings

    The average redistribution rate to losers was significantly higher in the brute luck treatment (48% of own endowment) compared to the option luck treatment (38%), suggesting that individuals have stronger preferences for redistribution toward individuals who suffer bad brute luck compared to individuals who suffer from equally bad outcomes due to bad option luck.

    Conclusions / Implications

    We find strong support for people having a fairness preference not just for outcomes, but also for how those outcomes are reached. Our findings are potentially important for understanding the role citizens assign individual responsibility for life outcomes, i.e. health and wealth. 

  • 24.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, The Institute of Technology.
    Bör vi tillåta betalning för organ?2012In: Moderna läkare, ISSN 1403-5502, no 2, 18-19 p.Article in journal (Other (popular science, discussion, etc.))
  • 25.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Discounting, Preferences, and Paternalism in Cost-Effectiveness Analysis2012In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 20, no 3, 297-318 p.Article in journal (Refereed)
    Abstract [en]

    When assessing the cost effectiveness of health care programmes, health economists typically presume that distant events should be given less weight than present events. This article examines the moral reasonableness of arguments advanced for positive discounting in costeffectiveness analysis both from an intergenerational and an intrapersonal perspective and assesses if arguments are equally applicable to health and monetary outcomes. The article concludes that behavioral effects related to time preferences give little or no reason for why society at large should favour the present over the future when making intergenerational choices regarding health. The strongest argument for discounting stems from the combined argument of diminishing marginal utility in the presence of growth. However, this hinges on the assumption of actual growth in the relevant good. Moreover, current modern democracy may be insufficiently sensitive to the concerns of future generations. The second part of the article categorises preference failures (which justify paternalistic responses) into two distinct groups, myopic and acratic. The existence of these types of preference failures makes elicited time preferences of little normative relevance when making decisions regarding the social discount rate, even in an intrapersonal context. As with intergenerational discounting, the combined arguments of growth and diminishing marginal utility offer the strongest arguments for discounting in the intrapersonal context. However, there is no prima facie reason to assume that this argument should apply equally to health and monetary values. To be sure, selecting an approach towards discounting health is a complex matter. However, the life-ordeath implications of any approach require that the discussion not be downplayed to merely a technical matter for economists to settle.

  • 26.
    Tinghög, Gustav
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    QALY och rättvisa2012In: QALY som effektmått inom vården: Möjligheter och begränsningar / [ed] Lars Bernfort, Linköping: Linköping University Electronic Press, 2012, 65-75 p.Chapter in book (Other academic)
  • 27.
    Tinghög, Gustav
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Societal cost of skin cancer compared to road traffic accidents (oral presentation)2008In: The 7th European Conference on Health Economics,2008, 2008Conference paper (Other academic)
  • 28.
    Tinghög, Gustav
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    The Art of Saying No: The Economics and Ethics of Healthcare Rationing2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    It follows from resource scarcity that some form of healthcare rationing is unavoidable. This implies that potentially beneficial medical treatments must be denied to patients to avoid unacceptable sacrifices in other areas of society. By focusing on four, core, conceptual themes – individual responsibility, paternalism, incentives, and inequality – this thesis explores the matter of finding justifiable grounds for saying no in the context of health care.

    By combining the perspectives of welfare economics and population-level ethics, the author explicate and discusses conflicting moral values involved in healthcare rationing. Four papers form the foundation for this thesis. Paper I articulates the potential role of individual responsibility as a welfarepromoting, rationing tool by exploring when healthcare services exhibit characteristics that facilitate individual responsibility for private financing. Paper II explores the normative relevance of individuals’ time preferences in healthcare rationing and when paternalism can be justified in the context of individuals’ intertemporal health choices. Paper III examines the compatibility between incentive-based organ donation and the ethical platform for setting priorities in Sweden. Paper IV empirically  investigates the existence of horizontal inequalities in using waiting lists to ration care.

    From the discussion it is suggested, inter alia, that: I) Prospective responsibility as opposed to retrospective responsibility is a more productive notion of responsibility when discussing actual policies. However, potential positive effects need to be weighed against the increased economic inequality that it is likely to invoke. II) Although cost-effectiveness analysis provides valuable input when making rationing decisions it should not be viewed as a decision rule, since it is based on utilitarian values that constantly need to be balanced against other nonutilitarian values. III) Potentially, increased health could negatively affect individuals’ well-being if it creates opportunities that they are unable to take advantage of. This needs to be taken into account before embarking on paternalistic policies to improve health – policies that often target the lower socioeconomic segment.

    The author concludes that decisions on rationing cannot be computed through a simple formula. Moreover, given that rationing is bound to be associated with reasonable disagreements we are unlikely to ever fully  resolve these disagreements. However, by explicitly stating conflicting moral values we are more likely to narrow the disagreements and achieve a healthcare system that is both fairer and more efficient.

    List of papers
    1. Individual responsibility for what?: A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system
    Open this publication in new window or tab >>Individual responsibility for what?: A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system
    2010 (English)In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134X, Vol. 5, no 2, 201-223 p.Article in journal (Refereed) Published
    Abstract [en]

    Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framwork for exploring when health-care services contain characteristics that facilitate individual responsibility through private financing. Six attributes for exploring the suitability of private financing for specific health-care commodities are identified: (i) it should enable individuals to value the need and quality both before and after utilization; (ii) it should be targeted toward individuals with a reasonable level of individual autonomy; (iii) it should be associated with low levels of positive externalities; (iv) it should be associated with a demand sufficient to generate a private market; (v) it should be associated with payments affordable for most individuals; and finally, (vi) it should be associated with 'lifestyle enhancements' rather than 'medical necessities'. The tentative framework enables exploration of individual responsibility connected to health care as a heterogeneous group of commodities, and allows policymakers to make decisions on rationing by design rather than default.

    Place, publisher, year, edition, pages
    Cambridge University Press, 2010
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy Economics
    Identifiers
    urn:nbn:se:liu:diva-56316 (URN)10.1017/S174413310999017X (DOI)
    Available from: 2012-11-23 Created: 2010-05-07 Last updated: 2015-09-22Bibliographically approved
    2. Discounting, Preferences, and Paternalism in Cost-Effectiveness Analysis
    Open this publication in new window or tab >>Discounting, Preferences, and Paternalism in Cost-Effectiveness Analysis
    2012 (English)In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 20, no 3, 297-318 p.Article in journal (Refereed) Published
    Abstract [en]

    When assessing the cost effectiveness of health care programmes, health economists typically presume that distant events should be given less weight than present events. This article examines the moral reasonableness of arguments advanced for positive discounting in costeffectiveness analysis both from an intergenerational and an intrapersonal perspective and assesses if arguments are equally applicable to health and monetary outcomes. The article concludes that behavioral effects related to time preferences give little or no reason for why society at large should favour the present over the future when making intergenerational choices regarding health. The strongest argument for discounting stems from the combined argument of diminishing marginal utility in the presence of growth. However, this hinges on the assumption of actual growth in the relevant good. Moreover, current modern democracy may be insufficiently sensitive to the concerns of future generations. The second part of the article categorises preference failures (which justify paternalistic responses) into two distinct groups, myopic and acratic. The existence of these types of preference failures makes elicited time preferences of little normative relevance when making decisions regarding the social discount rate, even in an intrapersonal context. As with intergenerational discounting, the combined arguments of growth and diminishing marginal utility offer the strongest arguments for discounting in the intrapersonal context. However, there is no prima facie reason to assume that this argument should apply equally to health and monetary values. To be sure, selecting an approach towards discounting health is a complex matter. However, the life-ordeath implications of any approach require that the discussion not be downplayed to merely a technical matter for economists to settle.

    Place, publisher, year, edition, pages
    Springer, 2012
    Keyword
    Cost-effectiveness analysis; Discounting; Paternalism; Preference failures; Time preferences
    National Category
    Medical and Health Sciences Philosophy Medical Ethics Health Care Service and Management, Health Policy and Services and Health Economy Economics
    Identifiers
    urn:nbn:se:liu:diva-65394 (URN)10.1007/s10728-011-0188-6 (DOI)000306591400006 ()
    Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2015-09-22
    3. Incentivizing deceased organ donation: A Swedish priority-setting perspective.
    Open this publication in new window or tab >>Incentivizing deceased organ donation: A Swedish priority-setting perspective.
    2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 2, 156-163 p.Article in journal (Refereed) Published
    Abstract [en]

    AIMS: The established deceased organ donation models in many countries, relying chiefly on altruism, have failed to motivate a sufficient number of donors. As a consequence organs that could save lives are routinely missed leading to a growing gap between demand and supply. The aim of this paper is twofold; firstly to develop a proposal for compensated deceased organ donation that could potentially address the organ shortage; secondly to examine the compatibility of the proposal with the ethical values of the Swedish healthcare system.

    METHODS: The proposal for compensating deceased donation is grounded in behavioural agency theory and combines extrinsic, intrinsic and signalling incentives in order to increase prosocial behaviour. Furthermore the compatibility of our proposal with the values of the Swedish healthcare system is evaluated in reference to the principles of human dignity, needs and solidarity, and cost effectiveness.

    RESULTS: Extrinsic incentives in the form of a €5,000 compensation towards funeral expenses paid to the estate of the deceased or family is proposed. Intrinsic and signalling incentives are incorporated by allowing all or part of the compensation to be diverted as a donation to a reputable charity. The decision for organ donation must not be against the explicit will of the donor.

    CONCLUSIONS: We find that our proposal for compensated deceased donation is compatible with the values of the Swedish healthcare system, and therefore merits serious consideration. It is however important to acknowledge issues relating to coercion, commodification and loss of public trust and the ethical challenges that they might pose.

    Place, publisher, year, edition, pages
    SAGE, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-65395 (URN)10.1177/1403494810391522 (DOI)000288065000006 ()21239479 (PubMedID)
    Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2015-09-22Bibliographically approved
    4. Horizontal Inequality in Rationing by Waiting Lists
    Open this publication in new window or tab >>Horizontal Inequality in Rationing by Waiting Lists
    2014 (English)In: International Journal of Health Services, ISSN 0020-7314, E-ISSN 1541-4469, International Journal of Health Services, ISSN 0020-7314, Vol. 44, no 1, 169-184 p.Article in journal (Refereed) Published
    Abstract [en]

    The objective of this article was to investigate the existence of horizontal inequality in access to care for six categories of elective surgery in a publicly funded system, when care is rationed through waiting lists. Administrative waiting time data on all elective surgeries (n = 4,634) performed in Östergötland, Sweden, in 2007 were linked to national registers containing variables on socioeconomic indicators. Using multiple regression, we tested five hypotheses reflecting that more resourceful groups receive priority when rationing by waiting lists. Low disposable household income predicted longer waiting times for orthopedic surgery (27%, p < 0.01) and general surgery (34%,p < 0.05). However, no significant differences on the basis of ethnicity and gender were detected. A particularly noteworthy finding was that disposable household income appeared to be an increasingly influential factor when the waiting times were longer. Our findings reveal horizontal inequalities in access to elective surgeries, but only to a limited extent. Whether this is good or bad depends on one's moral inclination. From a policymaker's perspective, it is nevertheless important to recognize that horizontal inequalities arise even though care is not rationed through ability to pay.

    Place, publisher, year, edition, pages
    Baywood Publishing Company, Inc., 2014
    Keyword
    Rationing, waiting list, horizontal equity, elective surgery, Sweden
    National Category
    Medical and Health Sciences Philosophy Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-65396 (URN)10.2190/HS.44.1.j (DOI)000331060500010 ()
    Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2015-09-22Bibliographically approved
  • 29.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Are Individuals Luck Egalitarians?: An Experiment on the Influence of Brute and Option Luck on Social Preferences2016Report (Other academic)
    Abstract [en]

    According to luck egalitarianism, inequalities should be deemed fair as long as they follow from individuals’ deliberate and fully informed choices, i.e. option luck – while inequalities should be deemed unfair if they follow from choices over which the individual has no control, i.e. brute luck. This study investigates if individuals’ fairness preferences correspond with the luck egalitarian fairness position. More specifically, in a laboratory experiment we test how individuals choose to redistribute gains and losses that stem from option luck compared to brute luck.

    A two-stage experimental design with real incentives was employed. In total, 226 subjects were randomly assigned to either the brute luck or option luck treatment. Treatments were identical except for how monetary compensation for participation in the experiment was settled in stage one. In the option luck treatment, subjects were given the option to chose between a safe option (50 SEK) and a risky option (a 50/50 gamble between 0 SEK and 150 SEK). In the brute luck treatment no such choice was given, instead all subjects were compensated based on outcome of the risky option. In the second stage, subjects were asked to distribute additional endowments (100 SEK) in an anonymous dictator game using the strategy method, i.e. making decisions contingent on the recipient losing or wining in the gamble.

    Individuals change their action associated with re-allocation depending on the underlying conception of luck. Subjects in the brute luck treatment equalized outcomes to larger extent (p=0.0069). Thus, subjects redistributed a larger amount to unlucky losers and a smaller amount to lucky winners compared to equivalent choices made in the option luck treatment.

    We find strong support for people having a fairness preference not just for outcomes, but also for how those outcomes are reached. Our findings are potentially important for understanding the role citizens assign individual responsibility for life outcomes, i.e. health and wealth.

  • 30.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Bonn, Caroline
    University of Innsbruck, Austria.
    Böttiger, Harald
    Klarna AB, Stockholm, Sweden.
    Josephson, Camilla
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Lundgren, Gustaf
    Stockholm School of Economics, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Kirchler, Michael
    University of Innsbruck, Austria.
    Johannesson, Magnus
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Intuition and cooperation reconsidered2013In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 498, no 7452, E1-E2 p.Article in journal (Refereed)
    Abstract [en]

    Rand et al.1 reported increased cooperation in social dilemmas after forcing individuals to decide quickly1. Time pressure was used to induce intuitive decisions, and they concluded that intuition promotes cooperation. We test the robustness of this finding in a series of five experiments involving about 2,500 subjects in three countries. None of the experiments confirms the Rand et al.1 finding, indicating that their result was an artefact of excluding the about 50% of subjects who failed to respond on time.

  • 31.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Department of health care analysis, Linköping university .
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Bonn, Caroline
    Johannesson, Magnus
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Stockholm School of economics .
    Kiirchler, Michael
    University of Innsbruck.
    Koppel, Lina
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Intuition and Moral Decision-Making: The Effect of Time Pressure and Cognitive Load on Moral Judgment and Altruistic Behavior2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 10, e0164012Article in journal (Refereed)
    Abstract [en]

    Do individuals intuitively favor certain moral actions over others? This study explores the role of intuitive thinking—induced by time pressure and cognitive load—in moral judgment and behavior. We conduct experiments in three different countries (Sweden, Austria, and the United States) involving over 1,400 subjects. All subjects responded to four trolley type dilemmas and four dictator games involving different charitable causes. Decisions were made under time pressure/time delay or while experiencing cognitive load or control. Overall we find converging evidence that intuitive states do not influence moral decisions. Neither time-pressure nor cognitive load had any effect on moral judgments or altruistic behavior. Thus we find no supporting evidence for the claim that intuitive moral judgments and dictator game giving differ from more reflectively taken decisions. Across all samples and decision tasks men were more likely to make utilitarian moral judgments and act selfishly compared to women, providing further evidence that there are robust gender differences in moral decision-making. However, there were no significant interactions between gender and the treatment manipulations of intuitive versus reflective decision-making.

  • 32.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Linköping University, Department of Management and Engineering, Economics.
    Andersson, David
    Linköping University, Department of Science and Technology. Linköping University, The Institute of Technology.
    Tinghög, Petter
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Lyttkens, Carl H.
    Department of Economics, Lund University.
    Horizontal Inequality in Rationing by Waiting Lists2014In: International Journal of Health Services, ISSN 0020-7314, E-ISSN 1541-4469, International Journal of Health Services, ISSN 0020-7314, Vol. 44, no 1, 169-184 p.Article in journal (Refereed)
    Abstract [en]

    The objective of this article was to investigate the existence of horizontal inequality in access to care for six categories of elective surgery in a publicly funded system, when care is rationed through waiting lists. Administrative waiting time data on all elective surgeries (n = 4,634) performed in Östergötland, Sweden, in 2007 were linked to national registers containing variables on socioeconomic indicators. Using multiple regression, we tested five hypotheses reflecting that more resourceful groups receive priority when rationing by waiting lists. Low disposable household income predicted longer waiting times for orthopedic surgery (27%, p < 0.01) and general surgery (34%,p < 0.05). However, no significant differences on the basis of ethnicity and gender were detected. A particularly noteworthy finding was that disposable household income appeared to be an increasingly influential factor when the waiting times were longer. Our findings reveal horizontal inequalities in access to elective surgeries, but only to a limited extent. Whether this is good or bad depends on one's moral inclination. From a policymaker's perspective, it is nevertheless important to recognize that horizontal inequalities arise even though care is not rationed through ability to pay.

  • 33.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Andersson, David
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Tinghög, Petter
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Health and Society.
    Lyttkens, Carl Hampus
    Lunds universitet.
    Rationing in practice - inequalities in waiting times for elective surgery (poster)2010Conference paper (Refereed)
  • 34.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Arts and Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Västfjäll, Daniel
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Decision Research, Eugene, OR, USA.
    Are Individuals Luck Egalitarians? – An experiment on the influence of brute and option luck on social preferences2017In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 8, 460Article in journal (Refereed)
    Abstract [en]

    According to luck egalitarianism, inequalities should be deemed fair as long as they follow from individuals’ deliberate and fully informed choices (i.e., option luck) while inequalities should be deemed unfair if they follow from choices over which the individual has no control (i.e., brute luck). This study investigates if individuals’ fairness preferences correspond with the luck egalitarian fairness position. More specifically, in a laboratory experiment we test how individuals choose to redistribute gains and losses that stem from option luck compared to brute luck. A two-stage experimental design with real incentives was employed. We show that individuals (n = 226) change their action associated with re-allocation depending on the underlying conception of luck. Subjects in the brute luck treatment equalized outcomes to larger extent (p = 0.0069). Thus, subjects redistributed a larger amount to unlucky losers and a smaller amount to lucky winners compared to equivalent choices made in the option luck treatment. The effect is less pronounced when conducting the experiment with third-party dictators, indicating that there is some self-serving bias at play. We conclude that people have fairness preference not just for outcomes, but also for how those outcomes are reached. Our findings are potentially important for understanding the role citizens assign individual responsibility for life outcomes, i.e., health and wealth. 

  • 35.
    Tinghög, Gustav
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Can it be left to individual responsibilty?2006In: The 6th International Conference in Priorities in Health Care,2006, 2006Conference paper (Other academic)
    Abstract [en]

      

  • 36.
    Tinghög, Gustav
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Health-care rationing by default or by design? - a conceptual framework for exploring individual responsibility connected to health-care commodities (oral presentation)2008In: The 7th International Conference on Priorities in Health Care,2008, 2008Conference paper (Other academic)
    Abstract [en]

        

  • 37.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, The Institute of Technology. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Individual responsibility for healthcare financing: application of an analytical framework exploring the suitability of private financing of assistive devices2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 8, 784-794 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To operationalise and apply a conceptual framework for exploring when health services contain characteristics that facilitate individuals’ ability to take individual responsibility for health care through out-of-pocket payment. In addition, we investigate if the levels of out-of-pocket payment for assistive devices (ADs) in Sweden are in line with the proposed framework. Method: Focus groups were used to operationalise the core concepts of sufficient knowledge, individual autonomy, positive externalities, sufficient demand, affordability, and lifestyle enhancement into a measurable and replicable rationing tool. A selection of 28 ADs were graded separately as having high, medium, or low suitability for private financing according to the measurement scale provided through the operationalised framework. To investigate the actual level of private financing, a questionnaire about the level of out-of-pocket payment for the specific ADs was administered to county councils in Sweden. Results: Concepts were operationalised into three levels indicating possible suitability for private financing. Responses to the questionnaire indicate that financing of ADs in Sweden varies across county councils as regards co-payment, full payment, discretionary payment for certain healthcare consumer groups, and full reimbursement. According to the framework, ADs commonly funded privately were generally considered to be more suitable for private financing. Conclusions: Sufficient knowledge, individual autonomy, and sufficient demand did not appear to influence why certain ADs were financed out-of-pocket. The level of positive externalities, affordability, and lifestyle enhancement appeared to be somewhat higher for ADs that were financed out-of-pocket, but the differences were small. Affordability seemed to be the most influential concept.

  • 38.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Lyttkens, Carl H.
    Lund University, Lund, Sweden.
    Individual responsibility for what?: A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system2010In: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134X, Vol. 5, no 2, 201-223 p.Article in journal (Refereed)
    Abstract [en]

    Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framwork for exploring when health-care services contain characteristics that facilitate individual responsibility through private financing. Six attributes for exploring the suitability of private financing for specific health-care commodities are identified: (i) it should enable individuals to value the need and quality both before and after utilization; (ii) it should be targeted toward individuals with a reasonable level of individual autonomy; (iii) it should be associated with low levels of positive externalities; (iv) it should be associated with a demand sufficient to generate a private market; (v) it should be associated with payments affordable for most individuals; and finally, (vi) it should be associated with 'lifestyle enhancements' rather than 'medical necessities'. The tentative framework enables exploration of individual responsibility connected to health care as a heterogeneous group of commodities, and allows policymakers to make decisions on rationing by design rather than default.

  • 39.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Synnerstad, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Rosdahl, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    How costly is skin cancer for society?2009In: Forum for Nordic Dermato-Venerology, ISSN 1402-2915, Vol. 14, no 1, 12-14 p.Article in journal (Other academic)
    Abstract [en]

    The annual cost of skin cancer in Sweden in 2005 was estimated to be -142.4 million (-15/inhabitant). When comparing direct costs only cost associated with medical consumption, skin cancer is more costly than the equivalent costs of both multiple sclerosis and brain tumours, and is close to the cost of breast cancer.

  • 40.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Synnerstad, Ingrid
    Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland. Linköping University, Faculty of Health Sciences.
    Rosdahl, Inger
    Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland. Linköping University, Faculty of Health Sciences.
    Samhällskostnader för hudcancer samt en jämförelse med kostnaderna för vägtrafikolyckor2007Report (Other academic)
    Abstract [en]

    Skin cancer is one of the most rapidly increasing cancers among the Swedish population and a significant cause of illness and death. The aim of this study was to from a societal perspective estimate the total cost of skin cancer in Sweden in 2005, using a combined top-down and bottom- up, prevalence based cost of illness approach. The total cost of skin cancer was estimated to 1,25 billion SEK (1 €= 9,3 SEK). The direct costs were estimated to 665 million SEK and constituted 53 percent of the total cost. Indirect costs were estimated to 583 million SEK and constituted 47 percent of the total cost. The main cost driver was production lost caused by premature death, amounting to 39 percent of the total cost.

    In addition, this study compares the cost of skin cancer with the costs arising from road traffic accidents. Focusing on the methodological differences that arise when comparing economic cost founded on similar but yet different methods when conducting cost analysis. We demonstrate that the seemingly large difference between the cost of skin cancer and the cost arising from road traffic accident, in reality is not as large as it first appear.

  • 41.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Synnerstad, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Rosdahl, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Societal Cost of Skin Cancer in Sweden 20052008In: Acta Dermato-Venereologica, ISSN 0001-5555, Vol. 88, no 5, 467-473 p.Article in journal (Refereed)
    Abstract [en]

    Skin cancer is one of the most rapidly increasing cancers among the Swedish population and a significant cause of illness and death. This study aims to estimate the total societal cost of skin cancer in Sweden 2005, using a prevalence based cost-of-illness approach. The total cost of skin cancer was estimated to € 142.4 million (€ 15 per inhabitant), of which € 79.6 million (€ 8 per inhabitant) were spent on health services and € 62.8 million (€ 7 per inhabitant) were due to production loss. The main cost driver was resource utilisation in outpatient care, amounting to 42.2% of the total cost. Melanoma was the most costly skin cancer diagnosis. Non-melanoma skin cancer was however the main cost driver for health services alone. In the future it is important to establish effective preventive measures to avoid increasing costs and suffering caused by skin cancer.

  • 42.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Kalkan, Almina
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Public health and where its focus should be2011In: Australian and New Zealand journal of public health, ISSN 1326-0200, E-ISSN 1753-6405, Vol. 35, no 4, 317-317 p.Article in journal (Other academic)
  • 43.
    Tinghög, Gustav
    et al.
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Sandman, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Högskolan i Borås, Institutionen för vårdvetenskap.
    Centrala begrepp vid prioriteringar2013In: Att välja rättvist: om prioriteringar i hälso- och sjukvården / [ed] Per Carlsson och Susanne Waldau, Lund: Studentlitteratur, 2013, 1, 35-48 p.Chapter in book (Other academic)
    Abstract [sv]

    Hälso- och sjukvårdens resurser räcker inte till alla behov och önskemål från patienter och medborgare, vilket gör att personal och beslutsfattare hamnar i svåra situationer. Hur ska vi veta att det är rätt patienter som tvingas stå tillbaka? Att välja rättvist tar upp centrala begrepp och etiska principer kring prioriteringar. Boken beskriver även metoder för att göra prioriteringar på ett systematiskt sätt och erfarenheter av såväl nationella som internationella prioriteringar.

    Prioriteringsbeslut fattas på alla nivåer och kan gälla fördelning av resurser till olika verksamheter, behandlingsbeslut av enskilda patienter eller investeringar i nya medicinska metoder. Boken ger förslag på hur beslutsunderlagen kan förbättras. Här ges anvisningar om hur man mäter behov och nytta hos patientgrupper och i befolkningen, hur kostnadseffektivitet beräknas och hur man skapar ett kunskapsunderlag. På så sätt får läsaren inte bara ta del av prioriteringarnas teori utan även av deras praktik, inte minst genom konkreta exempel på hur öppna prioriteringar i dag tillämpas i svensk hälso- och sjukvård.

    Boken är avsedd för dig som arbetar kliniskt eller planerar att arbeta med prioriteringar – nationellt, i landsting eller i kommuner. Boken ger även en värdefull inblick för dig som vill lära mer om hur vårdens svåra val ska kunna hanteras i framtiden.

  • 44.
    Tinhög, Gustav
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Andersson, David
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Tinghög, Petter
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Health and Society.
    Lyttkens, Carl Hampus
    Lunds universitet.
    Rationing in practice - inequalities in waiting times for elective surgery (poster)2010Conference paper (Refereed)
  • 45.
    Västfjäll, Daniel
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decision Research, Eugene, OR, USA.
    Erlandsson, Arvid
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Lund University, Sweden.
    Slovic, Paul
    Decision Research, Eugene, OR, USA; University of Oregon, Eugene, OR, USA.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Commentary: Empathy and its discontents2017In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, 542Article in journal (Other academic)
    Abstract [en]

    In “Empathy and its discontents” Bloom (2017: see also Bloom, 2016) argues that we should abandon empathy as a moral compass in favor of compassion. Bloom’s central premise is that empathy is narrow in its focus on single identified individuals, biased in that it favors the in-group, and can be used as a tool to motivate us to do things that are not optimally effective, or even destructive (e.g., motivate war). For all these reasons, Bloom argues that policy decision should not be motivated by empathy. There is indeed ample evidence that empathy is fraught with biases and we have, as Bloom, argued that deliberate mechanisms are needed to counteract the innumeracy and parochialism of empathy (Slovic and Västfjäll, 2010). While there is much to agree with Bloom on, there are a few points where we disagree; (1) the definition of compassion, (2) data supporting why empathy, but not compassion, is bad, (3) the role of deliberation in moral judgment. 

  • 46.
    Västfjäll, Daniel
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Paul, Slovic
    Decision Research Eugene, OR, USA.
    Burns, William
    Decision Research Eugene, OR, USA.
    Erlandsson, Arvid
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Koppel, Lina
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Asutay, Erkin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    The Arithmetic of Emotion: Integration of Incidental and Integral Affect in Judgments and Decisions2016In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 7, 325- p.Article in journal (Refereed)
    Abstract [en]

    Research has demonstrated that two types of affect have an influence on judgment and decision making: incidental affect (affect unrelated to a judgment or decision such as a mood) and integral affect (affect that is part of the perceiver’s internal representation of the option or target under consideration). So far, these two lines of research have seldom crossed so that knowledge concerning their combined effects is largely missing. To fill this gap, the present review highlights differences and similarities between integral and incidental affect. Further, common and unique mechanisms that enable these two types of affect to influence judgment and choices are identified. Finally, some basic principles for affect integration when the two sources co-occur are outlined. These mechanisms are discussed in relation to existing work that has focused on incidental or integral affect but not both.

  • 47.
    William, Hagman
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    David, Andersson
    Linköping University, Department of Management and Engineering, Economics.
    Daniel, Västfjäll
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis.
    Public Views on Policies Involving Nudges2015In: Review of Philosophy and Psychology, ISSN 1878-5158, E-ISSN 1878-5166, Vol. 6, no 3, 439-453 p.Article in journal (Refereed)
    Abstract [en]

    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. 

  • 48.
    Wiss, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Slovic, Paul
    Decis Res, Honolulu, HI USA; Univ Oregon, Eugene, OR 97403 USA.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Res, Honolulu, HI USA.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    The influence of identifiability and singularity in moral decision making2015In: Judgment and decision making, ISSN 1930-2975, E-ISSN 1930-2975, Vol. 10, no 5, 492-502 p.Article in journal (Refereed)
    Abstract [en]

    There is an increased willingness to help identified individuals rather than non-identified, and the effect of identifiability is mainly present when a single individual rather than a group is presented. However, identifiability and singularity effects have thus far not been manipulated orthogonally. The present research uses a joint evaluation approach to examine the relative contribution of identifiability and singularity in moral decision-making reflecting conflicting values between deontology and consequentialism. As in trolley dilemmas subjects could either choose to stay with the default option, i.e., giving a potentially life-saving vaccine to a single child, or to actively choose to deny the single child the vaccine in favor of five other children. Identifiability of the single child and the group of children was varied between-subjects in a 2x2 factorial design. In total 1,232 subjects from Sweden and the United States participated in three separate experiments. Across all treatments, in all three experiments, 32.6% of the subjects chose to stay with the deontological default option instead of actively choosing to maximize benefits. Results show that identifiability does not always have a positive effect on decisions in allocation dilemmas. For single targets, identifiability had a negative or no effect in two out of three experiments, while for the group of targets identifiability had a more stable positive effect on subjects’ willingness to allocate vaccines. When the effect of identifiability was negative, process data showed that this effect was mediated by emotional reactance. Hence, the results show that the influence of identifiability is more complex than it has been previously portrayed in the literature on charitable giving. 

  • 49.
    Wiss, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    David, Andersson
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Prioritizing Rare Diseases: Psychological Effects Influencing Medical Decision Making2017In: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681XArticle in journal (Refereed)
    Abstract [en]

    Background. Measuring societal preferences for rarity has been proposed to determine whether paying pre- mium prices for orphan drugs is acceptable. Objective. To investigate societal preferences for rarity and how psychological factors affect such preferences. Method. A postal survey containing resource allocation dilemmas involving patients with a rare disease and patients with a common disease, equal in severity, was sent out to a randomly selected sample of the population in Sweden (return rate 42.3%, n = 1270). Results. Overall, we found no evidence of a general preference for prioritizing treat- ment of patients with rare disease patients over those with common diseases. When treatment costs were equal, most respondents (42.7%) were indifferent between the choice options. Preferences for prioritizing patients with common diseases over those with rare diseases were more frequently displayed (33.3% v. 23.9%). This tendency was, as expected, amplified when the rare disease was costlier to treat. The share of respondents choosing to treat patients with rare diseases increased when present- ing the patients in need of treatment in relative rather than absolute terms (proportion dominance). Surprisingly, identifiability did not increase preferences for rarity. Instead, identifying the patient with a rare disease made respondents more willing to prioritize the patients with common diseases. Respondents’ levels of education were significantly associated with choice—the lower the level of education, the more likely they were to choose the rare option. Conclusions. We find no support for the existence of a general preference for rarity when setting health care priorities. Psychological effects, especially proportion dominance, are likely to play an important role when pre- ferences for rarity are expressed.  

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