Alf Erling Risa

Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain

&NA; In general, randomized controlled studies concerning return to work have failed to demonstrate significant treatment effects for long‐lasting musculoskeletal pain, and most treatments examined have not been economically beneficial. Individuals (n=654) sick‐listed for at least 8 weeks with musculoskeletal pain, selected from the Norwegian mandatory sickness insurance system and volunteering to participate, were categorized into three groups differing in a prognosis score (good, medium, poor) for return to work, based on a brief, standardized screening of psychological and physiotherapy findings. They were then randomly assigned to three outpatient treatments with three different levels of intensity (ordinary treatment, light multidisciplinary, and extensive multidisciplinary treatment). The evaluation was based on 14 months follow‐up data on return to work collected from social security records. The patients with good prognosis for return to work do equally well with ordinary treatment as with the two more intensive treatments. The patients with medium prognosis benefit equally from the two multidisciplinary treatments. The patients with poor prognosis receiving extensive multidisciplinary treatment returned to work at a higher rate than patients with poor prognosis receiving ordinary treatment, 55 vs. 37% (P<0.05) at 14 months. Multidisciplinary treatment is effective concerning return to work, when given to patients who are most likely to benefit from that treatment. Measures of pain or quality of life are not included in this study. The cost–benefit analysis of the economic returns of the light multidisciplinary and the extensive multidisciplinary treatment programs yields a positive net present social value of the treatment. A simple, standardized, screening instrument including only psychological and physiotherapeutic observations may be a useful clinical tool for allocating patients with musculoskeletal pain to the right level of treatment.

Reforming social security in a small open economy

Abstract We examine funding strategies for social security in a small open economy. A life cycle based dynamic simulation approach derives transition paths of policies that phase down social security in a pre-announced and gradual manner. Agents are free to allocate goods and leisure time over their life span. In addition, a ‘joy of giving’ bequest motive is taken into account. The model is calibrated to the Norwegian social security system. We find that both the announcement and the endogenous responses in the labor market and through bequests, offset most of the intergenerational redistribution problems occurring during the transition.

Generational accounting and intergenerational welfare

We investigate the intergenerational welfare implications of Generational Accounting when it is used as the basis for intertemporal fiscal policy decisions. In particular, we consider an economy with a PAYGO social security system out of steady state due to a permanent fall in fertility. In a highly stylized CGE overlapping generations model we illustrate that policy recommendations based on a standard application of Generational Accounting may not be compatible with intertemporal welfare maximization. Our model provides an example where such policies are either time inconsistent or welfare-decreasing.

The Welfare State as Provider of Accident Insurance in the Workplace: Efficiency and Distribution in Equilibrium

The welfare state provides universal insurance for workers against accidents in the workplace. In equilibrium, this insurance does not generate adverse safety incentives to firms. Noninternalized insurance makes workers sort themselves nonoptimally to firms and choose higher individual effort levels to prevent accidents as compared to insurance schemes that are internalized in the market. Welfare state insurance may, therefore, generate higher safety levels than perfect experience rating, not lower. An optimal income taxation scheme in the welfare state implies progressive taxation. The optimal tax level increases with the extent of the welfare state. Copyright 1995 by Royal Economic Society.

Ability, Self-Confidence, and Search

We explore optimal search for individual improvement when agents start with different confidence in own ability. The initial self-confidence may be determined by nature or socio-economic factors.

Familienpolitik in Norwegen

Ein wichtiges Merkmal der skandinavischen Wohlfahrtsstaaten, die in der zweiten Halfte dieses Jahrhunderts entstanden sind, war die Schaffung staatlicher Unterstutzungsleistungen an Familien mit Kindern. Mit dieser Politik sollte vor allem ein Beitrag zu mehr Chancengleichheit fur (alle) Kinder, was Lebensstandard und Ausbildung angeht, geleistet werden. Gleichzeitig wurde mit der Familienpolitik in Norwegen und eher noch ausgepragter in Schweden ein weiteres Ziel angestrebt. Sie sollte die weibliche Beteiligung am Arbeitsmarkt und damit auch die wirtschaftliche Unabhangigkeit von Frauen fordern.

Market Insurance, Social Insurance, and Education

We show that social disability insurance may better society-wide welfare even when there is a perfect private market for similar insurance. In essence, the public system complements the private. The latter cover risks when personal characteristics are known, whereas the first mitigates effects of unfavorable characteristics. Large social insurance benefits will induce more education among agents with expected good health. These same agents also experience a negative redistributive income effect from social insurance. Incentive effects to redistribution are therefore nonstandard since individuals that are adversely affected by redistribution will respond with more educational vigor.

Technological Diffusion Through Profit Seeking And Epidemic Information Processes

Explanations of technological diffusion focus on information being spread by epidemic processes, on profit heterogeneity, or oligopolistic competition. The model in this paper integrates the epidemic and the heterogeneity-based approaches. Predictions are tested on Norwegian data concerning the diffusion of laboratory equipment in primary health care. The empirical analysis shows that both diffusion of information, and profitability considerations, are significant factors in explaining technological diffusion. The integrated model performs significantly better than any submodel. Our analysis also gives indications of the impact of public reimbursement policies on physician behavior.

Preference revelation in strict liability product safety markets

Strict liability rules in markets where product safety is an issue have two potential justifications that have been put forth in the literature. The most common justification is that strict liability provides incentives to producers to supply safe products. This notion is often based on an idea of persisting consumer misperceptions regarding the quality, or riskiness, of the products, as analyzed by Spence (1977) and Danzon (1984). The incidence of product-related accidents may, however, also depend on the consumers’ incentives to take precautions. A potential problem with strict liability regulation from this point of view is therefore that provision of safetyenhancing incentives to producers may provide disincentives to precautionary activities for consumers. This point was forcefully made by Oi (1973). He concluded that proper incentives to consumers often are more appropriate than producer liability to address the accident problem. Another justification for product liability regulation, which has been advocated by Epstein (1985), is that regulation provides better insurance coverage for risk-averse consumers as compared to an imperfect market insurance system.’ Strict liability does indeed provide comprehensive insurance coverage, but it is not obvious that the incentive problems regarding the consumers are less in a regulated environment as compared to a market setting. The opposite view is more widely held and was stated by Rea (1985) in a direct comment to Epstein (1985). In response to this criticism, strict liability rules are usually modified with the defense of contributory negligence to take account of consumer incentives. This joint incentive scheme has also dominated the theoretical literature on liability rules, but also relationships between strict liability, safety regulation, and social insurance have been explored.3 This literature has established that strict liability with the defense of

Coexistence of Private and Public Health Care: Some Implications for Demand and Resource Allocation

The coexistence of a private and a public health care system influences the total allocation of resources to health care in an economy. The present analysis focuses on the impact of an exogenous public supply policy on individual agents’ demand for private health care. Structurally the analysis is very simple, and it is embedded in a quite standard moral hazard model where individual agents maximize the expected utility of treatment within a stochastic medical technology. The strength of this approach is that the model is tractable, and it generates strong, and empirically testable, restrictions on the coefficients of the reduced forms. Furthermore, the analysis provides a framework that supports intuition on the relationship between a public and a private health care system.