This dissertation consists of three quantitative papers addressing contemporary issues in health policy. The first paper draws on a survey of 2,678 adults from the United States and four European countries to assess demand for a hypothetical early medical test for Alzheimer's disease (AD). Overall, 67% of respondents reported that they would be "very" or "somewhat" likely to get the test if it were available. Through logistic regression analysis, we find that interest was higher among those worried about developing AD, with an immediate blood relative with AD, and who have provided care for AD patients. Knowing that AD is fatal did not influence demand, except among those with an affected blood relative. We expect that a test becoming available could precipitate the creation of a large constituency of asymptomatic, diagnosed adults, affecting a range of health policy decisions. The second paper utilizes Current Population Survey data to explore state-level Medicaid enrollment rates among eligible parents between 2003 and 2010, focusing on the interaction of race and ethnicity and political ideology. Using logistic regression analysis, we find that average take-up for Hispanics in conservative states was 23%, whereas take-up was 38% for both whites and blacks in those states, adjusting for state and individual demographics. These differences abated in liberal and moderate states. Among eligible Hispanics, enrollment rates were less than half as high in conservative states than in liberal states (23% versus 61%). Adjusting for differences in state Medicaid policies narrowed these disparities significantly, highlighting the importance of new provisions aimed at streamlining enrollment procedures across all states. The last paper draws on public and private data from 2007 to 2010 to analyze how administrative spending by health insurers and providers varied across states with different levels of insurance and hospital market concentration. Using regression analysis, we find that in provider offices, high levels of insurance concentration were associated with lower administrative costs. If all states were as concentrated as the most concentrated state in our sample, we would expect nationwide savings of $3.6 billion in administrative expenses. However, market concentration did not reduce administrative spending by insurers or hospitals.

Bakgrund: Olika forskare har under åren identifierat problem relaterade till inflation, samt även bidragit med förslag på lösningar på dessa. Begreppet Money Illusion är ett välkänt begrepp inom området som tycks vara en del i förklaringen till allmänhetens motvilja att hantera inflationsrelaterade problem. Det är bestämt i Sverige av Riksbanken att inflationen skall vara låg men positiv och inflationsmålet är satt till två procent. Indexerade beräkningsenheter presenteras av Robert Shiller som lösning på kunskaps- och beteendeproblem förknippade med inflation. Han definierar en indexerad beräkningsenhet som ska fungera parallellt med den lokala valutan. Syfte: Syftet är att diskutera förutsättningar för en implementering av nya indexerade beräkningsenheter, som fungerar parallellt med valutan, i Sverige samt att kritiskt granska Robert Shillers teorier om indexerade beräkningsenheter. Genomförande: Uppsatsen är av kvalitativ karaktär och bygger på semistrukturerade intervjuer med personer inom bank- och försäkringsväsendet samt en universitetslektor i nationalekonomi vid Linköpings Universitet. Intervjuerna har utgått från samma intervjumall. Insamlat intervjumaterial har tillsammans med teorier om inflation, indexering och transaktionskostnader legat till grund för analysen. Slutsats: Slutsatsen i uppsatsen är att den låga inflation som råder i Sverige inte ses som ett tillräckligt stort problem för att motivera en mer vida indexering hos privatpersoner. De kostnader som förknippas med indexering, i form av transaktionskostnader, har även underskattats av Robert Shiller vilket gör att hans förespråkande för indexering i låginflationsländer i själva verket högst troligen är en paradox. / Background: Several scientists have, over the years, identified problems related to inflation and contributed with suggestions to solutions. The term Money Illusion is a well-known phenomenon that explains difficulties of separating nominal value from real value. The central bank of Sweden has decided that inflation should be low but positive and the inflation target is set to two percent. Robert Shiller presents Indexed Units of Account as a solution to problems related to inflation depending on knowledge and behavior. He defines an Indexed Unit of Account that is meant to operate in parallel to the local currency. Aim: The aim is to discuss the prerequisites for an implementation of new indexed units of account, which works in tandem with the currency, in Sweden as well as critically examine the theories of indexed units of account made by Robert Shiller. Completion: The thesis is qualitative in nature and is based on semi-structured interviews with people in banking, insurance and a senior lecturer in economics at the University of Linköping. The interviews have assumed the same interview template. Collected interview data, together with theories of inflation, indexing and transaction costs has formed the basis for the analysis. Conclusion: The conclusion in the paper is that the low inflation prevailing in Sweden is not seen as a big enough problem to warrant a more widespread use of indexation by individuals. Robert Shiller has also underestimated the costs associated with indexing, in the form of transaction costs, which most likely means that his advocacy of indexation is a paradox.

The purpose of this study is to examine how construction logistics work for the ongoing project “Årstastråket” Stage 1, and to identify the logistics problems that the project may have. The aim then is to find solutions to these problems in order to avoid them in the upcoming projects. The study will include delopment of a standard template that can be used in logistics planning of the project. At the beginning of the study a comprehensive literature review of the available literature including reports and research articles was done to obtain a deeper knowledge of the subject in question. The result of this study is based on conducted case studies on the construction site, such as interviews and site visits. The majority of collection in the case study was mainly collected from 11 site visits, which then was supplemented with the information obtained from the interviews. The interviews were conducted with the local manager and supervisor of the project at “Årstastråket” Stage 1. In this study the construction logistics worked generally well, both in terms of transport- and material flow at the construction site. The main logistics problems identified in “Årstastråket” Stage 1 was particularly poor logistics planning of the project at an early stage, lack of visual communication and constant updating of construction site plan alongside project developing. The new developed standard template for logistics planning of the project at an early stage can be used in order to achieve the established goals and make the project even more effective.

Rheumatoid arthritis (RA) is a major cause of progressive joint damage and disability, and is associated with decline in quality of life, reduced ability to work and increased health care utilisation. The economic consequences of the disease are substantial for the individuals and their families and for the society as a whole. This thesis describes a 5-year follow up of 320 patients with early RA, enrolled between January 1996 and April 1998 in the Swedish multi-centre inception cohort TIRA (early interventions in rheumatoid arthritis). Health status, function and costs were investigated. Predictors of high costs were calculated, and an algorithm was constructed to predict future need for TNFinhibitor treatment in patients not responding to traditional disease-modifying antirheumatic drugs (DMARDs). Clinical and laboratory data, measures of functional capacity and self-reported assessments were collected regularly. In addition, patients completed biannual/annual questionnaires concerning all health care utilisation and days lost from work due to the disease. Within 3 months, improvements were seen regarding all variables assessing disease activity and functional ability, but 15% of the patients had sustained high or moderate disease activity throughout the study period. The scores of ‘health assessment questionnaire’ (HAQ) were similar for men and women at baseline, but had a less favourable course in women, who also had DMARDs more frequently prescribed. Ambulatory care accounted for 76% of the direct costs during the first year. Women had more ambulatory care visits and higher usage of complementary medicine compared to men. Men ≥65 years had low costs compared to younger men and compared to women of all ages. In multiple logistic regression tests, HAQ, high levels of IgM-class rheumatoid factor (RF), and poor hand function increased the odds of incurring high direct costs. Poor hand function and pain increased the odds of incurring high indirect costs. Indirect costs exceeded direct costs all three years. The average direct costs were €3,704 (US$ 3,297) year 1 and €2,652 (US$ 2,360) year 3. All costs decreased over the years, except those for medication and surgery. The indirect costs were €8,871 (US$ 7,895) year 1 and remained essentially unchanged, similarly for both sexes. More than 50% were on sick leave or early retirement at inclusion. Sick leave decreased but was offset by increase in early retirement. 14 patients (5%) were prescribed TNF-inhibitors at the 3- year follow up, thus increasing drug costs substantially. However, they incurred higher costs even before prescription of anti-TNF therapy. At the 5-year follow-up (2001-2003), 31 patients (12%) were prescribed TNFinhibitors. Baseline values of erythrocyte sedimentation rate, C-reactive protein, anti-CCP antibodies and morning stiffness were significantly higher in this group. These patients were also to a larger extent RF-positive and carriers of the ‘shared epitope’ (SE). Anti-TNF treated patients were significantly younger and more often women. For men, a predictive model was constructed using baseline data including SE+ and IgA-RF >100 U/L and anti-CCP >240 U/L yielding a specificity of 98% and a sensitivity of 71%. For women, disease activity score (DAS28) at the 3-month follow-up proved to be a better predictor, and the final model comprised SE+ and 3-month DAS28>5.2, giving a specificity of 95% and a sensitivity of 59%.

Performance goals for a highway system are an indication of the desired system condition, and the level of service to be provided to its users. Setting the appropriate performance goals has a significant impact on the way highway agencies conduct business. With growing needs and limited resources, the consequences of setting different levels of performance goals should be examined and compared to optimize the highway infrastructure needs at the network level. Three interacting sets of costs are typically considered for a complete economic appraisal of highway projects: construction, maintenance and road use costs. Due to the shift in focus from design-and-build mode to the repair-and-maintain mode, this study focuses on maintenance related costs and the road user cost aspects only. Maintenance and rehabilitation activities on pavement infrastructure are ongoing processes that are required for the entire road network. This suggests that for long planning horizons and geographically extensive networks, their application usually results in significant financial needs. Typically, highway agencies have based their policy decisions such as the target condition levels for the system on the budget needs for maintenance and rehabilitation actions. Since in most cases, the funding needs exceed the available budget, the required preventive and routine maintenance activities suffer or are overlooked completely. Failure to timely apply these maintenance actions cause the pavements to deteriorate more rapidly into condition states that require for more expensive rehabilitation actions during the life cycle of the pavement. Over time, a vicious cycle is instigated in which the maintenance and rehabilitation needs of the network keep increasing each year. Although most highway administrators acknowledge the fact that pavement preservation is perhaps the most effective way of using the limited budgets available, the costs associated with deferring maintenance actions is oftentimes overlooked when establishing performance goals for the system. Road user costs in the form of costs for vehicle operation have been recognized as another large component of the total transportation related costs. These costs are then arguably the most important to consider for a complete economic appraisal. Ironically, they are also often disregarded while making important policy decisions. Other road user costs such as those related to the impact of traffic congestion and detours caused by construction and maintenance activities are difficult to quantify and were not accounted for in this study. Although it is widely accepted that establishing suitable performance goal is critical for system maintenance and preservation, a framework that considers the inter-relationship between conflicting objectives of minimum maintenance and rehabilitation costs, deferred maintenance costs, and vehicle operating costs to the users does not exist. This thesis proposes a methodological framework that is aimed at assisting highway agencies with the problem of objectively analyzing policy decisions in terms of the performance goals for their highway networks that would minimize the total transport costs to the society. In a case study of the proposed framework, the highway network managed by the Texas Department of Transportation was examined for different performance goals. The results from the case study indicate that setting lower performance goals lead to savings in the M&R needs, but at the same time, they also significantly increase the exogenous costs such as deferred maintenance costs and the vehicle operating costs. / text

This dissertation consists of three essays in Labor Economics. The first chapter estimates the costs for establishments of hires and separations for a panel of German establishments. The panel records the start and the termination of the employment of all employees in the surveyed establishments, allowing estimation of adjustment costs under different assumptions of how frequently establishments revise their labor demand. Under the assumption that establishments revise their labor demand every month, estimates suggest hiring costs per employee of approximately 5,000 Euros, and costs of separations of 1,000 Euros. Hiring costs vary considerably between skilled (8,000 to 28,000 Euros per hire) and unskilled (4,000 to 8,000 Euros) labor. Spatial aggregation (large establishments) is associated with lower cost estimates, and only monthly adjustment frequencies yield estimates consistent with theoretical predictions. The second chapter analyzes the role of regional ethnic capital - defined as the average years of schooling of ethnic groups - in the educational attainment of young second generation immigrants in Germany using information on naturalization and country of birth in a nationally representative survey. I find evidence for externalities of ethnic capital for ethnic groups. A higher average education of ethnics makes attendance of higher-quality secondary schools more likely. Moreover, the effect is mainly mediated through the ethnic concentration in the region. However, if higher than regional aggregates are used for the measurement of ethnic capital, no externalities are detected. The third chapter analyzes the impact of regional own-ethnic concentration on the language proficiency of immigrants in Germany. It solves the endogeneity of immigrants' location choices by exploiting the fact that guest-workers in Germany after WWII were initially placed by firms and labor agencies. We find a robust negative effect of ethnic concentration on immigrants' language ability. Simulation results of a simultaneous location and learning choice model confirm the presence of the effect and show how immigrants with high learning cost select into ethnic enclaves. Under the counterfactual scenario of a regionally equal distribution of immigrants the share of German-speakers increases only modestly. / text

"Audience costs" models of international relations suggest a purely informational role for domestic politics in conflict settings. Here, domestic politics serve as a rich signal of belligerents' true intentions, allowing them to more quickly resolve disagreements, decreasing the likelihood and duration of war. But if belligerents can have different beliefs about publicly available information, then domestic politics might confuse rather than clarify conflict situations, increasing the likelihood and duration of war. I present empirical evidence of conventional "audience costs" models' shortcomings in explaining the dynamics of the US counterinsurgency efforts in Iraq and the response of Iraqi insurgents to those efforts. I then develop a formal model to show how differences in beliefs between insurgents and counterinsurgents about domestic political audiences in Iraq may have contributed to the prolonged nature of the conflict. I argue that the underlying cause of the conflict's duration is disagreement between belligerents about whether and how Iraqi civilians contribute to a successful counterinsurgency, leading belligerents to disagree not only before fighting about who is likely to win, but during fighting about who is actually winning. / text

published_or_final_version / Housing Management / Master / Master of Housing Management

published_or_final_version / Real Estate and Construction / Master / Master of Philosophy

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