Swedish Institute for Health Services Development

OBJECTIVESBrain tumours cause considerable concern due to a high mortality and there are increasing efforts to provide adequate care, sometimes outside hospitals. Health care utilisation, direct costs of care, and the indirect social cost of morbidity and early mortality caused by brain tumours in Sweden in the year 1996 was analysed.METHODSQuantification of ambulatory care, care in hospital, long term and palliative/terminal care, drug consumption, temporary as well as long term morbidity, and mortality from comprehensive national data sources. Direct costs were calculated using 1996 charges. Indirect costs were calculated by sex and age specific salaries. A sensitivity analysis considered the impact of alternative estimates of each item.RESULTSIndirect costs were 75% of the total and were caused mainly by early mortality. Direct costs were predominantly for care in hospital, long term care, and home health care. Among direct costs, astrocytomas III-IV and meningiomas accounted for 42% and 30% respectively.CONCLUSIONSThe cost of illness from brain tumours reflects the characteristics of these malignancies. Despite their low incidence rate, the economic impact caused by high mortality among young persons is a predominant trait. Costs of acute hospital care and also long term care and home care are considerable.

Abstract The assessment of patient satisfaction with services has become an issue of increasing interest in the evaluation of psychiatric services. However, several methodologic problems concerning study designs, sampling, reliability, and validity have been raised. A further problem in the field has been the great number of ad hoc instruments used, which has made comparisons between studies cumbersome. In Sweden a collaborative project has been performed with the aim of developing a patient-satisfaction instrument for use in routine clinical quality-of-care assessments and in psychiatric health care services research. Two versions of a patient-satisfaction questionnaire have been developed, one for use in inpatient services and one for use in community care services. In this article data on the development and use of the instruments and a summary of reliability and validity studies are given. Results from nationwide pilot studies of out-and in-patients have shown reliability coefficients of the questionnaires to be satisfactory. Content validity studies has been performed, and the results showed that dimensions of care given the highest priority by patients were well covered in the two questionnaires. The influence of yea-saying or acquiescence on ratings of satisfaction were found to be low and non-significant. Different modes of administering the instruments have been tested, resulting in lower response rates when the instrument was used as a postal questionnaire.Key Words: Outcome measurersPatient satisfactionPsychiatric services researchQuality of care

Smoking habits among different occupational groups in Sweden were estimated from nation wide surveys of living conditions in 1977 and 1980/81. These surveys were conducted by Statistics Sweden and consist of interviews covering the Swedish population aged 16-74 years. The sample includes about 12,000 persons for each of the two investigations. The results show that those who may be exposed to excess risks in their work environment, smoke more than those in other occupational groups. Transport and manufacturing workers, miners, wood and paper workers and painters, for example, have higher rates of daily smokers than the national average. The highest rates, however, were found among the category of early retired or unemployed. These findings confirm that an appropriate evaluation of occupationally-related diseases affected by smoking must take smoking data into consideration. If smoking data are available from other sources, adjusted work-related risks could be calculated. This presumes the absence of interaction effects. Procedures are given and illustrated. The paper also discusses the declining trends in smoking habits between 1977 and 1980/81 and possible reasons for differences in smoking habits between occupations.