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By: Richard M. Max Mara

Recently, universal healthcare is a common term heard in politics and on the news. What exactly is it? Universal healthcare is rooted in the belief that healthcare is a human right. A right that should be provided by the government. More and more countries are implementing it and it seems to be working for them. Many worry though, does it work?

A 2017 observational study takes a close look at this. This study analyzed the Swedish Salut Child Health Intervention Programme in Västerbotten. For context, the Salut Programme is a universal health initiative aimed to improve maternal and child health. They do this by offering government-funded health insurance to mothers which, in turn, extends to their children until they reach the age of 2. This program is intended to provide complete and comprehensive healthcare for new mothers, taking off some of the economic weight associated motherhood.

The study compared Sweden’s care-as-usual healthcare to government-funded medical care. Care-as-usual being privatized healthcare that people used before the Salut Programme. According to the study’s findings, the program yielded higher results in overall health and lower costs than care-as-usual (Häggström 2017).

Researchers set out with the intention of investigating the efficiency and cost-effectiveness of the Salut Programme over the periods of the prenatal period, delivery, and the child’s first two years of life. They chose these periods because they are all associated with the health and well-being of adults. Meaning, early-life health, and prosperity have an impact on the adult.

The main goal of the study was to assess the efficacy of the program by comparing health outcomes and costs between geographical areas covered by Salut (Salut area) and those not (non-Salut area). As controls, they included mothers from both areas if their child was born in 2002-2004 (pre-measure period) or 2006-2008 (post measure period). Meaning, these mothers and their children were outside the coverage of the Salut Programme, but similar enough chronologically and health-wise to be used as controls. On top of this, researchers made sure to consider possible confounding variables such as the mother’s smoking status, cesarean section birth, and the child’s health at birth. To reduce error, they also followed up on the pediatric health of the participants regularly during their first two years of life.

The outcomes were clustered into the four categories mentioned before: pregnancy, delivery, birth, and the child’s early life. The data was then organized using a matched difference-in-difference analysis, including a longitudinal analysis for mothers who gave birth in both the pre-measure and post measure periods. For reference, a matched difference-in-difference analysis is essentially a bar graph that shows parallel trends. While a longitudinal analysis is a fancy way to say the researchers repeatedly observed the same variables. In this case, the health of mothers and their children in the pre and post measure periods.

The researchers made a successful attempt at a valid study and acknowledged any possible bias or limitations of the study. The economic evaluation of the study was performed from medical care and a limited societal perspective. To have a limited societal perspective, a study must look to improve the health and well-being of society as a whole. On top of this, they listed the strengths and limitations of the study. The study was limited by the lack of previous evidence “base” on this topic, the lack of data relating to primary care and medication, and that the economic evaluation only included productivity losses with inpatient and outpatient care. These limitations do not hinder the study enough to classify it as invalid.

The previously mentioned lack of “base” on the topic was an issue encountered in another study on tissue-based sequencing in a universal healthcare system (Hynes 2017). This issue is not uncommon. Although not entirely new, universal healthcare is not established enough to be experimented on often. This will be a common limitation until there is enough reputable literature on universal healthcare.

In the future, to create a better study on this specific topic, methods of the experiment would need to be improved. First, the researchers would need more access to medical records. Data on primary care and medication is integral to this study, especially when considering costs. Second, the study should have tracked the overall quality of life for longer. In defense of the article, it did cite outside information that shows a linked relationship between early-life health and adult health. However, for the most accurate results, the researchers should have utilized a more long-term time frame for the study. Lastly, a more in-depth look at productivity when it comes to cost-effectiveness should have been done. Although they did acknowledge that their results may be a bit uncertain, looking at inpatient and outpatient care alone is not extensive enough. To conclude 100% that the Salut Programme is cost-effective, the study should have included all other healthcare costs associated with pregnancy and early child-life.


Featured Image:

Photo by Christian Bowen on Unsplash; Free-to-use Images


Häggström, Jenny, Filipa Sampaio, Eva Eurenius, Anni-Maria Pulkki-Brännström, Anneli Ivarsson, Marie Lindkvist, and Inna Feldman. 2017.  Is the salut programme an effective and cost-effective universal health promotion intervention for parents and their children? A register-based retrospective observational study.  Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden: BMJ Journals.

Hynes, S., Pang, B., James, J. 28 February 2017. Tissue-based next generation sequencing: application in a universal healthcare system. Br J Cancer 116, 553–560 (2017).

Forsdahl, A. 1977; Are poor living conditions in childhood and adolescence an important risk factor for arteriosclerotic heart disease? Journal of Epidemiology & Community Health ;31:91-95.

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