Essay 1: Individuals with higher socioeconomic status (SES) also tend to enjoy better health. Evidence from the economics literature suggests that a potential mechanism behind this “social health gradient” is that human capabilities, that form SES, also facilitate health-promoting behaviors. This essay empirically investigates the significance of socioeconomic differences in health behaviors, using dental care consumption as an operationalization of health investments. I focus on adults at an age where lifetime trajectories for SES can be taken as given and use lifetime income to capture SES. I estimate the impact of lifetime income on dental care consumption and find robust evidence that the social gradient in dental care consumption steepens dramatically over the life-cycle. Considering that dental care consumption only reflects a small part of individuals' health investments the results suggest that lifetime effects of SES on health behaviors could be substantial in other dimensions. Essay 2: This essay studies the effect of competition on prices on a health care market where prices are market determined, namely the Swedish market for dental care. The empirical strategy exploits that the effect of competition differs across services, depending on the characteristics of the service. Price competition is theoretically more intense for services such as examinations and diagnostics (first-stage services), compared to more complicated and unusual treatments (follow-on services). By exploiting this difference, I identify a relative effect of competition on prices. The results suggest small but statistically significant negative short-term effects on prices for first-stage services relative to follow-on services. The results provide evidence that price-setting among dental care clinics responds to changes in the market environment and substantial effects of competition on prices over time cannot be ruled out. Essay 3: The Swedish dental care insurance subsidizes dental care costs above a threshold and becomes more generous as dental care consumption increases. On average, higher-income individuals consume more dental care and have better oral health than low-income individuals. Therefore, the redistributional effects of the Swedish dental care insurance are ambiguous a priori. I find that the dental care insurance adds to the progressive redistribution taking place through other parts of the Swedish social insurance (SI) for individuals aged 35-59 years whereas it reduces the progressivity in the SI for those aged 60-89 years. While the result for the oldest individuals is problematic from an equity point of view, the insurance seems to strengthen the progressitivy of the Swedish social insurance for the vast majority of patients.

On December 26th, 2004, 280,000 people lost their lives. A massive earthquake struck Indonesia, triggering a tsunami that affected several countries, including Thailand. The disaster had important implications for health status of Thai citizens, as well as health system planning, and thus underscores the need to study its long-term effect. This dissertation examined the patterns, determinants, and spatial analysis of health service utilization following the tsunami in Thailand. The primary aim was to determine whether tsunami-affected status (personal injury or property loss) and distance to a health facility (public health center or hospital) influenced health service utilization. The study population included Thai citizens (aged 14+), living in the tsunami-affected Thai provinces: Phuket, Phang Nga, Krabi, and Ranong. Study participants were randomly selected from the ‘affected’ and ‘unaffected’ populations. One and two years after the tsunami, participants were interviewed in-person on demographic and socio-economic factors, disaster impact, health status, and health service utilization. Five types of health services were examined: outpatient services, inpatient services, home visits, medications, and informal (unpaid) care. Distance to a health facility was calculated using Geographic Information System’s Network Analyst. The Grossman model of the demand for health care and a distance decay concept provided the foundation for this study. A propensity score method and a two-part model were used to examine the study objectives. There were 1,889 participants. One year after the tsunami, individuals affected by property loss were more likely to use medications than unaffected participants. Two years after the tsunami, individuals with personal injury were more likely to use outpatient services, medications, and informal care than unaffected participants. Distance to a health facility was associated with the use of medications and informal care. The results confirmed the long-term effect of a tsunami. This dissertation may assist the decision- and policy-makers in the identification of those most likely to use health services and in the request of health resources to the affected areas. The patterns, determinants, and spatial analysis of health service utilization found in this study may not be specific to a tsunami and may provide insights on post-disaster contexts of other natural disasters.

On December 26th, 2004, 280,000 people lost their lives. A massive earthquake struck Indonesia, triggering a tsunami that affected several countries, including Thailand. The disaster had important implications for health status of Thai citizens, as well as health system planning, and thus underscores the need to study its long-term effect. This dissertation examined the patterns, determinants, and spatial analysis of health service utilization following the tsunami in Thailand. The primary aim was to determine whether tsunami-affected status (personal injury or property loss) and distance to a health facility (public health center or hospital) influenced health service utilization. The study population included Thai citizens (aged 14+), living in the tsunami-affected Thai provinces: Phuket, Phang Nga, Krabi, and Ranong. Study participants were randomly selected from the ‘affected’ and ‘unaffected’ populations. One and two years after the tsunami, participants were interviewed in-person on demographic and socio-economic factors, disaster impact, health status, and health service utilization. Five types of health services were examined: outpatient services, inpatient services, home visits, medications, and informal (unpaid) care. Distance to a health facility was calculated using Geographic Information System’s Network Analyst. The Grossman model of the demand for health care and a distance decay concept provided the foundation for this study. A propensity score method and a two-part model were used to examine the study objectives. There were 1,889 participants. One year after the tsunami, individuals affected by property loss were more likely to use medications than unaffected participants. Two years after the tsunami, individuals with personal injury were more likely to use outpatient services, medications, and informal care than unaffected participants. Distance to a health facility was associated with the use of medications and informal care. The results confirmed the long-term effect of a tsunami. This dissertation may assist the decision- and policy-makers in the identification of those most likely to use health services and in the request of health resources to the affected areas. The patterns, determinants, and spatial analysis of health service utilization found in this study may not be specific to a tsunami and may provide insights on post-disaster contexts of other natural disasters.

I denna studie har vi med ett kvantitativt tillvägagångsätt analyserat hur den självskattade hälsan hos en sjukdomspopulation förhåller sig till socioekonomiska faktorer, social kontext och de tre inkomsthypoteserna. De tre inkomsthypoteserna avser absolutinkomsthypotesen, relativinkomsthypotesen och inkomstskillnadshypotesen. Datamaterialet som ligger till grund för denna studie baseras på registerdata över cirka 7700 patienter över 18 år från Stockholms län som genomgått ryggkirurgi under åren 2006–2016. Den självskattade hälsan analyserades både vid inskrivningstillfället i samband med ryggkirurgi samt som förändringen i den självskattade hälsan från inskrivningstillfället till ett år efter operationen. Till vår vetskap har tidigare forskning inte i någon större utsträckning analyserat sambandet mellan socioekonomiska faktorer och förändringen i självskattad hälsa i samband med vårdinsats, vilket är en del av vårt forskningsbidrag. Resultaten indikerar att social kontext inte har ett statistiskt signifikant samband med förändringen i självskattad hälsa. Vid analys av den initiala hälsonivån finner vi dock tvetydiga resultat för inkomstskillnadshypotesen och relativinkomsthypotesen. Vi finner att absolutinkomsten har en positiv korrelation med den självskattade hälsan både vid inskrivningstillfället och vid förändringen. Vi finner även att universitetsutbildning har ett statiskt signifikant och positivt samband med förändringen i självskattad hälsa dock gäller inte detta för den självskattade hälsan vid inskrivningstillfället. Våra resultat indikerar även att vara född utanför Europa har en statistiskt signifikant negativ korrelation med den självskattade hälsan vid inskrivningstillfället samt vid förändringen i självskattad hälsa. Våra resultat ger en djupare förståelse för vilka faktorer som kan ligga till grund för skillnader i självskattad hälsa hos en sjukdomspopulation. Vidare ger studien underlag för utformning av policyrekommendationer som riktar sig mot en jämnare fördelning av hälsa i samhället genom implementering av tolk och individuellt anpassad information / In this study, we analyzed the correlation between differences in self-reported health, socioeconomic status, social context and the three income hypotheses. The three income hypotheses refer to the absolute income hypothesis, the relative income hypothesis and the income inequality hypothesis. The sample of our study consists of about 7700 individuals age 18 and above from Stockholm county who have gone through surgery due to back pain in the years 2006-2016. With a quantitative approach, we analyzed the correlations between socioeconomic status, social context and health at two times in conjunction to a health care input. To our knowledge has previous research not to a greater extent analyzed the connection between socioeconomic status and the change in health in connection to a health care input, which is part of the contribution of this study. The results indicate that social context does not have a statistically significant correlation with the change in health after a health care input, although we find ambiguous results for the income inequality hypothesis and the relative income hypothesis when analyzing the initial health status. We find that absolute income has a statistically significant and positive correlation with both the initial self-rated health and the change in self rated health over time. An education at university has a statistically significant and positive correlation with the change in self-rated health between the two-time periods, however we do not find this result for the initial health status. Our results indicate that to be born outside of Europe correlates negatively and statistically significant with the change in selfreported health and the initial health status. Our results give a deeper understanding and knowledge to which factors that could explain differences in health for a population with a defined disease. Furthermore, based on our results we give policy recommendations targeted at a more even distribution of health in Sweden through implementing the use of translators and individually customized information.