Health Economics, Policy and Law (1)
Theory and Practice of Logic Programming (1)
SICStus Prolog—The first 25 years
MATS CARLSSON, PER MILDNER
Journal: Theory and Practice of Logic Programming / Volume 12 / Issue 1-2 / January 2012
Published online by Cambridge University Press: 12 September 2011, pp. 35-66
SICStus Prolog has evolved for nearly 25 years. This is an appropriate point in time for revisiting the main language and design decisions, and try to distill some lessons. SICStus Prolog was conceived in a context of multiple, conflicting Prolog dialect camps and a fledgling standardization effort. We reflect on the impact of this effort and role model implementations on our development. After summarizing the development history, we give a guided tour of the system anatomy, exposing some designs that were not published before. We give an overview of our new interactive development environment, and describe a sample of key applications. Finally, we try to identify key good and not so good design decisions.
Individual responsibility for what? – A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system
Gustav Tinghőg, Per Carlsson, Carl H. Lyttkens
Journal: Health Economics, Policy and Law / Volume 5 / Issue 2 / April 2010
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 framework 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.
Early identification and assessment of new and emerging health technologies: Actions, progress, and the future direction of an international collaboration—EuroScan
Sue Simpson, Claire Packer, Per Carlsson, Jill M. Sanders, Iñaki Gutiérrez Ibarluzea, Anne-Florence Fay, Inger Norderhaug
Objectives: To report on a workshop, and subsequent discussions, that reviewed the achievements and progress of the EuroScan collaboration since its establishment in 1999 to share information on the methods and results of early identification and assessment of new and emerging health technologies; considered challenges to the collaboration; and discussed its possible future direction.
Methods: A workshop was held in Stockholm in September 2006, with thirty-two participants from ten countries and representatives from EuroScan member agencies, policy makers involved in policy or decision making relating to new technologies, and invited external commentators from international HTA networks. The workshop used a mix of presentations, panel and audience discussions, and small group work to consider the achievements and challenges put forward.
Results: EuroScan has developed as a sustainable network, and has made progress on all tasks in its initial action plan, with the EuroScan information sharing database on new and emerging technologies being one of the collaboration's key achievements. Identified immediate concerns for the network included consideration of the impact of its current name and membership model; acknowledgement and publication of the full range of benefits of membership; contribution to and development of the database to encourage increased information sharing; and EuroScan's ongoing interaction with the wider HTA world.
Conclusions: The workshop was a useful mechanism for reviewing the work of EuroScan and for creating a platform to take the collaboration forward. The workshop affirmed the benefits of the network to individual members; posed some significant challenges to the network to consider; and acted as a stimulus for an interim name change to better represent the global membership, and a major review of the EuroScan database of identified and assessed emerging health technologies.
Data validation in an economic evaluation of surgery for colon cancer
Martin Janson, Per Carlsson, Eva Haglind, Bo Anderberg
Journal: International Journal of Technology Assessment in Health Care / Volume 21 / Issue 2 / April 2005
Objectives: This study aimed to validate the accuracy of data retrieved in a prospective multicenter trial, the purpose of which was an economic evaluation of two techniques of surgery for colon cancer.
Methods: Within the Swedish contribution of the COLOR trial (Colon Cancer Open or Laparoscopic Resection), an economic evaluation of open versus laparoscopic surgical techniques was conducted. Data were collected by case record forms (CRF), patient diaries, and telephone surveys every 2 weeks. The study period was 12 weeks, and the perspective was societal. Data from the first consecutive forty patients to complete the health economic study protocol were validated. Retrieved data were compared with data from medical records and data from local social security offices for agreement.
Results: Statistically significant differences were found for duration of anesthesia, length of surgery, number of outpatient consultations by doctors and district nurses, complication rate, and the use of central venous lines. No significant differences were observed concerning length of hospital stay, disposable instruments cost, and time off work, all of which heavily influence total costs.
Conclusions: The present method of data collection regarding resources used in this setting seems to produce accurate data for economic evaluation; however, relative to complication rates, the method did not retrieve accurate data.
Health technology assessment and priority setting for health policy in Sweden
Per Carlsson
Journal: International Journal of Technology Assessment in Health Care / Volume 20 / Issue 1 / January 2004
This article describes the development of health technology assessment (HTA) in Sweden, its influence on decision making, and its link with priority setting. Sweden has a well established governmental HTA body, the Swedish Council on Technology Assessment in Health Care (SBU), and an increasing number of regional/local HTA organizations. HTA has had an impact on clinical practice and is used to some extent in policy decisions. Several initiatives have now been taken to develop processes for open priority setting of health-care services. With the establishment of a new agency to undertake reimbursement decisions on pharmaceuticals, and greater patient and public involvement in decision making, it seems inevitable that HTA will play a more important role in priority setting in the near future.
HEALTH TECHNOLOGY ASSESSMENT IN SWEDEN
Per Carlsson, Egon Jonsson, Lars Werkö, David Banta
Sweden has a welfare system that is based on the fundamental principle that all citizens are entitled to good health and medical care, regardless of where they live or what their economic circumstances are. Health and medical care are considered to be public sector responsibilities. However, there is growing interest in establishing more private alternatives to public care. An important characteristic of the Swedish healthcare system is its decentralization, with a major role for county councils. County councils are now merging into larger administrative units (region). The whole Swedish system is in the process of reform, mainly because of perceptions that it was too rigid and had insufficient patient orientation. An important factor in the reforms is that power in the system will be even more decentralized and will have greater public input. This change is seen as calling for increased central follow-up and evaluation of matters such as social, ethical, and economic aspects. Although the state has decentralized control, it still attempts to control the general direction of the system through regulation, subsidy, recommendations, and guidelines. An important actor in the system is the Swedish Council on Technology Assessment in Health Care (SBU). SBU began in 1987 with assessments of health technologies, but its success has recently led policy makers to extend its coverage to dental care. Health technology assessment is increasingly visible to policy makers, who find it useful in decision making.
Torben Jorgensen, Per Carlsson
Journal: International Journal of Technology Assessment in Health Care / Volume 14 / Issue 4 / Fall 1998
Print publication: Fall 1998
Scanning the Horizon for Emerging Health Technologies: Conclusions from a European Workshop
Per Carlsson, Torben Jorgensen
To share the existing, albeit limited, experience among nations and to explore the feasibility of international collaboration on the identification and early evaluation of health care technologies, an workshop was arranged in September 1997. Twenty-seven policy makers and researchers from twelve countries attended the meeting and concluded that: the policy environment in most European countries is characterized by insufficient data on safety, effectiveness, and cost-effectiveness of health care innovations; that an early warning system is perceived as an essential mechanism for facilitating communication among policy makers, technology experts, and health professionals; and that collaboration on early warning activities might be even more useful than traditional collaboration in health technology assessment.
The Early Experiences of a National System for the Identification and Assessment of Emerging Health Care Technologies in Sweden
Per Carlsson, Henric Hultin, Johanna Törnwall
This article presents the experiences from a pilot study and the establishment of a permanent system called SBU Alert. The question of establishing a system for the identification and assessment of emerging technologies in health care in Sweden has been on the agenda since the late 1980s. The demand came primarily from policy makers. The pilot study showed that the awareness of the project in the target group (politicians, leading managers, hospital directors, and senior medical advisors) was high. Almost all of those who replied to an assessment questionnaire were in favor of a continuation of the work. In 1997, the Swedish Council on Technology Assessment in Health Care (SBU) was selected to establish a permanent organization. This work has resulted in the identification of a number of methodological problems and tentative solutions concerning all components in the SBU Alert system. We have found that a system for systematic identification and early assessment of emerging technologies is a new and promising tool in the health technology assessment arsenal. Still, experiences are limited. Methodology and the impact of early judgments on decision making need further evaluation.
Effects of Federal Policies on Extracorporeal Shock Wave Lithotripsy,Elaine J. Power. Washington, D.C.: Office of Technology Assessment (OTA-HCS-36), 051986, 103 pp.
Journal: International Journal of Technology Assessment in Health Care / Volume 3 / Issue 4 / October 1987
Impact of Extracorporeal Lithotripsy on Patient Management: Intermediate Results from the Swedish Assessment Study
Per Carlsson, Bengt Jönsson, Hans-Göran Tiselius
Journal: International Journal of Technology Assessment in Health Care / Volume 3 / Issue 3 / July 1987
Sweden's first, and so far only, ESWL unit for kidney stone treatment became operational on April 1, 1985. This paper presents some intermediate results from an integrated medical, economic, and technical evaluation of the new technology. Seventy-eight percent of 477 patients were defined as successfully treated, totally stone free or fragments less than 4 mm in size, after a follow-up of four weeks. After six months, the share of successfully treated patients had increased to 82%. Successes were closely related to the stone situation; the smaller the stone, the greater success of treatment. Patients' experiences with treatment were also studied and showed that less than 5% of the patients perceived the treatment as unpleasant, frightening, and/or time consuming. Epidemiological data reveal that one unit can replace all open surgical operations on the kidney.