A large proportion of Swedish citizens refrain from seeking medical care--lack of confidence in the medical services a plausible explanation?

Equity in health and health care is and has been a long-standing goal in Swedish health care politics. This study aims to look into how different socio-demographic variables influence unmet needs i.e. why one would refrain from seeing a doctor, despite a perceived need for medical care. A nation-wide postal questionnaire was answered by 2648 (66%) randomly chosen individuals in the ages between 20 and 64 years. The questionnaire included questions on health and health care utilisation along with data on different socio-demographic variables. The proportion of citizens that refrain from visiting a physician despite a perceived need was higher (24%) than in any previous Swedish investigation. Women, those of a non-Swedish origin and those with a low level of education refrained from going to the physician to a higher extent than men, inborn citizens and those with a higher education. Stated reasons to why the respondents refrained from medical care were associated with confidence, primarily, finite availability and economy. It appears as the Swedish health care system is not fully adapted to provide for the so far unmet needs of a large proportion of the population and that this has equitable concerns.

The timing of introduction of pharmaceutical innovations in seven European countries.

RATIONALE, AIMS AND OBJECTIVES: Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries (United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. METHODS: We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). RESULTS AND CONCLUSIONS: The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care.

Social capital and inequality in health between single and couple parents in Sweden.

AIMS: To study whether social capital is associated with health among parents and if so, whether existing inequalities in health between single and couple parents could be better understood by introducing social capital as a possible mechanism for how health is distributed. MATERIAL AND METHODS: At total of 2,500 parents with children in the age range of 4-16 years were randomized from existing national registers and asked to participate in a nationally distributed postal questionnaire; 1,589 parents participated (277 single and 1,312 couple), giving a response rate of 64%. The questionnaire contained questions regarding sociodemographic and socioeconomic characteristics, self-rated health, emotional and instrumental social support, civic and social participation, and trust. Social capital was measured by different levels of civic and social participation and trust. A multivariate analysis was used in order to find possible associations between social capital and health, when adjusted for social support, sociodemographic and socioeconomic characteristics. RESULTS: A low level of social capital (both social participation and trust), when adjusted for social support, socioeconomic and sociodemographic variables, was clearly and positively associated with less than good self-rated health. Social capital was unevenly distributed between single and couple mothers. CONCLUSIONS: Social capital is positively associated with self-rated health, at an individual level. The uneven distribution of social capital between single and couple mothers may be of some importance when trying to further understand and possibly alter the inequality in health that exists between single and couple parents.

Health and healthcare utilization among single mothers and single fathers in Sweden.

AIMS: To analyse self-rated health and healthcare utilization with regard to whether the respondents were single or couple parents, mothers or fathers. METHODS: A postal questionnaire was distributed nationwide to 4,000 randomly chosen individuals 20-64 years of age, with a response rate of 66%. A total of 1,041 respondents had legal custody of a child (150 were single parents and 891 were couple parents), and thus met the definition of a parent used for this study. Analyses of self-rated health and health care utilization were performed according to sex, age, sociodemographic, and socioeconomic characteristics. Three different statistical methods were applied: Spearman correlation analyses, chi-square analyses and multivariate logistic regression. RESULTS: Both single fathers and single mothers reported worse health than their couple counterparts. However, single fathers had contact with a physician more frequently (OR 1.84) than couple fathers, whereas single mothers did not. Furthermore, single mothers refrained from seeing a physician despite a medical need much more often (OR 2.07) than couple mothers. CONCLUSIONS: An uneven distribution of sociodemographic and socioeconomic characteristics might help us to understand why single parents, both mothers and fathers, have worse health than parents who live together. Previously recognized gender differences with regard to healthcare utilization were present in our study as well, and it is possible that these differences are related to the unequal distribution of sociodemographic and socioeconomic assets between single fathers and single mothers found here.