Socio-Economic Evaluation of Mental Health as a Basis for Financing Health Care in Sweden

Article excerpt

The objective of this paper is to examine hypotheses about the relationships between socio-economic factors, risk factors in working life, and the occurrence of mental illness, together with the degree of quality of life and consumption of health care, costs for health care, and costs for social insurance. This is a prospective and longitudinal study of 1,347 individuals of an active working age, 18-64 years, who have been on sick leave for more than 30 days. The group is characterized by the prevalence of risk factors in their work environment and welfare losses, such as multiple health problems, poor quality of life, inability to work, and dependency on society's support from health care and social insurance. The costs for health care were just over 2.8 million SEK, or 30 percent higher for those with psychological distress as compared to the group without. The payments from social insurance also increased by approximately 15 percent. The relatively greater weighting of health care costs and sickness cash b enefits were motivating factors to study whether this group had an optimal amount and quality of health care, or if the resources available for health care should be distributed in another way that better satisfies the needs of the group. (JEL 100, D60)


The diagnostic group known as the mentally ill now represents approximately 15 percent of the socio-economic costs for illness in Sweden. The resources consumed by health care programs associated with mental illness were 18 billion Swedish Krona (SEK), or about $230 U.S. per inhabitant in 1990 [Hansson et al., 1993]. The productivity losses due to sick leave were 27 billion SEK (about $345 U.S. per inhabitant) [Davis and Wilde, 1996]. A review of the use of economic components in the evaluations of psychiatric services showed increased studies over time, but also revealed that there is a need to spread the knowledge about stringent methods in health economics in order to facilitate policy making [McCrone and Weich, 1996]. The risk of minor depression before the age of 65 years has been estimated to be 30 percent for women and 16 percent for men [Bebington et al., 1989]. Moreover, mental illness is frequently associated with physical problems [Sullivan, 1995]. There are also signs that the occurrence of these problems has been underestimated, which has brought about non-existent or irrelevant treatment of many patients [Franko et al., 1995; Katon et al., 1982; Isacsson and Bergman, 1997]. Mental illness is the basis of 18 percent of the recently awarded early retirement pensions, but only 9.1 percent of sick leave days and 1.8 percent of illness cases [National Board of Social Insurance, 1996]. It is only a few individuals with mental illness that are responsible for a relatively large proportion of early retirement pensions and sick leave days. Mental illness can also be present without being the direct cause of sick leave. The occurrence of mental illness in individuals on long--term sick leave, however, is not known. A population survey in which individuals in a sample of the Swedish population indicated their opinion about their own state of health showed that the rates of reported health problems related to anxiety or depression were not age-related [Ferraz-Nunes, 1999, 2000]. The rate peaked at 35 percent of respondents aged 40 to 49, then decreased mildly. About one-fourth of the respondents in the youngest group reported problems related to this dimension. Anxiety and depression are the main reported health problems in all ages.

This paper will concentrate on the county of Ostergotland in Sweden. In. 1995, approximately 13 percent of the population of the county of Ostergotland between the ages of 16-84 years had frequently occurring health problems in the form of sleeping problems, depression, worry, or anxiety [Rahmqvist and Jonsson, 1996]. In the group of full-time or part-time workers, the corresponding figure was 8. …