Machinery for the Adjustment of Disputes Under New Collective Agreements

Avhandlingen består av tre empiriska studier som undersöker effekten av socialt kapital för individernas arbetsmarknadsutfall, utifrån två huvudsakliga frågeställningar. För det första: Vilka individuella egenskaper, såsom utbildningsnivå, genus och ursprungsland, underlättar eller försvårar tillgång till socialt kapital? Här studeras den avkastning som socialt kapital genererar på arbetsmarknaden, jämfört med utbildning och arbetslivserfarenhet. För det andra analyseras vilken betydelse en stigmatiserad social identitet hos vissa invandrade har för tillgången till socialt kapital och i vilken grad ett ”underskott” av socialt kapital påverkar deras arbetsmarknadsutfall. Resultatet av de empiriska undersökningarna tyder på att invandrare och deras barn, efter kontroll för produktionsrelaterade variabler, har mindre tillgång till socialt kapital och därför sämre arbetsmarknadsutfall.This thesis consists of an introduction and three self-contained studies on the impact of social capital on individuals’ labour market outcomes. It focuses on labour market conditions for immigrants and their children in Sweden. The central research questions of the thesis are twofold. First, what individual characteristics, such as educational level, gender and country of origin, enhance or hinder access to social capital, and how well is social capital rewarded in the labour market compared with education and work experience? Second, does the stigmatized social identity of some immigrant groups affect their access to social capital, and to what degree does such a social capital ‘deficit’ affect their labour market outcomes? The results demonstrate that inequality between immigrants (and their children) and natives (and their children) in access to networks with valuable resources of social capital is an important issue in their labour market outcomes

Weighting must wait: incorporating equity concerns into cost effectiveness analysis may take longer than expected

Current practice in economic evaluation is to assign equal social value to a unit of health improvement (“a QALY is a QALY is a QALY”). Alternative views of equity are typically considered separately to efficiency. One proposal seeks to integrate these two sets of societal concerns by attaching equity weights to QALYs. To date, research in pursuit of this goal has focussed on candidate equity criteria and methods for estimating such weights. It has implicitly been assumed that should legitimate, valid, and reliable equity weights become available, it would be a straightforward task to incorporate them into as a separate simple calculation after estimating cost per unweighted QALY. This paper suggests that in many situations these simple approaches to incorporating equity weights will not appropriately reflect the preferences on which the weights are based and therefore equity weights must be incorporated directly into the cost effectiveness analysis. In addition to these technical issues, there are a number of practical challenges that arise from the movement from implicit to explicit consideration of equity. Equity weights should be incorporated in economic evaluation, but not until these challenges have been appropriately addressed

Orphan drugs and the NHS: Should we value rarity

Cost effectiveness plays an important part in current decisions about the funding of health technologies. Drugs for rare disease (orphan drugs) are often expensive to produce and, by definition, will benefit only small numbers of patients. Several countries have put measures in place to safeguard research and development of orphan drugs, but few get close to meeting the cost effectiveness criteria for funding by healthcare providers. We examine the justifications for special status for rare diseases and ask whether the cost effectiveness of drugs for rare or very rare diseases should be treated differently from that of other drugs and interventions

Weighting must wait: incorporating equity concerns into cost effectiveness analysis may take longer than expected

Current practice in economic evaluation is to assign equal social value to a unit of health improvement (“a QALY is a QALY is a QALY”). Alternative views of equity are typically considered separately to efficiency. One proposal seeks to integrate these two sets of societal concerns by attaching equity weights to QALYs. To date, research in pursuit of this goal has focussed on candidate equity criteria and methods for estimating such weights. It has implicitly been assumed that should legitimate, valid, and reliable equity weights become available, it would be a straightforward task to incorporate them into as a separate simple calculation after estimating cost per unweighted QALY. This paper suggests that in many situations these simple approaches to incorporating equity weights will not appropriately reflect the preferences on which the weights are based and therefore equity weights must be incorporated directly into the cost effectiveness analysis. In addition to these technical issues, there are a number of practical challenges that arise from the movement from implicit to explicit consideration of equity. Equity weights should be incorporated in economic evaluation, but not until these challenges have been appropriately addressed

Weighting must wait: incorporating equity concerns into cost effectiveness analysis may take longer than expected

Current practice in economic evaluation is to assign equal social value to a unit of health improvement (“a QALY is a QALY is a QALY”). Alternative views of equity are typically considered separately to efficiency. One proposal seeks to integrate these two sets of societal concerns by attaching equity weights to QALYs. To date, research in pursuit of this goal has focussed on candidate equity criteria and methods for estimating such weights. It has implicitly been assumed that should legitimate, valid, and reliable equity weights become available, it would be a straightforward task to incorporate them into as a separate simple calculation after estimating cost per unweighted QALY. This paper suggests that in many situations these simple approaches to incorporating equity weights will not appropriately reflect the preferences on which the weights are based and therefore equity weights must be incorporated directly into the cost effectiveness analysis. In addition to these technical issues, there are a number of practical challenges that arise from the movement from implicit to explicit consideration of equity. Equity weights should be incorporated in economic evaluation, but not until these challenges have been appropriately addressed

Drugs for exceptionally rare diseases: a commentary on Hughes et al

Recently in this journal, Hughes and colleagues discussed special funding status to ultra-orphan drugs. They concluded that there should be a uniform policy for the provision of orphan drugs across Europe; that complete restriction was impractical, and that UK policy should aspire to the values of the EU directive on orphan drugs. We critically assess these arguments, demonstrating that they failed to justify special status for treatments for rare diseases

Efficiency, equity, and NICE clinical guidelines

The stated purpose of clinical guidelines from the United Kingdom's National Institute for Clinical Excellence (NICE) is to "help healthcare professionals and patients make the right decisions about healthcare in specific clinical circumstances." However, what constitutes "the right decisions" depends on your point of view. For individual patients the right decision is that which maximises their wellbeing, and this is properly the concern of the clinician. Yet in resource constrained healthcare systems this will not always coincide with the right decisions for patients in general or society as a whole, thereby leading to some understandable tensions. NICE is a national policy making body whose responsibility is clearly broader than the individual patient. This wider viewpoint is reflected in NICE's technology appraisals by the central role afforded to cost effectiveness. We argue that the methods currently used by the NICE clinical guideline programme confuse these two viewpoints