PhD Defence: Andrea Berggren "Choices among Doctors, Students and Primary Care Providers"

Health and medicine
Society and economy

Andrea Berggren defends her thesis in economics "Choices among Doctors, Students and Primary Care Providers: Empirical Evidence from Sweden”.

26 May 2023
10:15 - 12:15


Professor Niklas Jakobsson, Handelshögskolan, University of Karlstads universitet

Grading committee

Førsteamanuensis Henning Øien, Institutt for helse og samfunn, Universitet i Oslo, Oslo, Norge

Professor Andreea Mitrut, Institutionen för nationalekonomi med statistik, Handelshögskolan vid Göteborgs universitet

Docent Mio Fredriksson, Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet


Docent Gustav Kjellsson, Institutionen för nationalekonomi med statistik, Handelshögskolan, Göteborgs universitet.



Chapter 1. Antibiotic consumption and health care utilization in children

As the global threat of antibiotic resistance grows more urgent, guidelines on the prudent use of antibiotics for human consumption are becoming commonplace worldwide, and access to antibiotics is increasingly restricted. This paper seeks to answer how being prescribed an antibiotic prescription in primary care affects children's health care utilization. To this end, I use the propensity of general practitioners (GPs) to prescribe antibiotics at an index visit for children ages 0-5. I show that GP behavior is unrelated to predetermined child characteristics, which allows for a causal interpretation of my results. The results show that being prescribed antibiotics at an index visit increases the probability of more interactions with the health care system in the short term. I estimate a precise increase in the probability of having at least one additional visit within 30 and 90 days, to both in- and out-of-hours primary care centers (PCCs), but no robust effect on either outpatient emergency visits nor hospitalizations. The results are robust to an extensive number of specification checks. I further corroborate the results by restricting the visits to those with respiratory tract infection, a common condition in children. The effects in this subsample are remarkably similar to those found for the full sample of visits. Overall, the results in this paper indicate that the GP's prescription decision has a substantial effect on the downstream use of health care services.

Chapter 2. The Impact of Upper Secondary School Flexibility on Sorting and Educational Outcomes
This paper estimates the causal impact of an upper secondary curriculum reform in Sweden that increased students’ course-taking flexibility in year 2000. In the most popular upper secondary program, it led to a significant decrease in mandatory mathematics requirements. Using administrative Swedish data, we estimate the causal impact of the reform on tertiary education outcomes and expected earnings using a differences-in-discontinuity identification strategy. The method compares students born immediately before and after the cutoff date. The inclusion of students born in neighbouring non-reform cutoff years enables us to disentangle the school starting age effect from the unconfounded effect of the reform. We find no negative effects of the reduced mathematics requirements. Rather, we find a positive effect of the reform on students’ probability of enrolling in, and earning a degree from, tertiary education. Our heterogeneity analysis suggests that relatively disadvantaged students were not negatively affected by the reform.

Chapter 3. Local media information and choice of primary health care provider
Patient choice in health care markets requires the patients to be well-informed about quality and act on this information. How patients choose providers, and how that is affected by various sources of information, remain open questions. We study how information from local media coverage influences choices of primary care providers. We use a novel source of information, local newspaper articles, as treatment in a staggered difference-in-difference framework to examine how media coverage affects the number of patients enrolled with a given primary care provider. We compare outcomes between treated and untreated providers before and after a negative or positive publication and perform event study and static difference-in-differences estimations. The main analysis does not detect any effect of either positive or negative coverage. The heterogeneity analysis reveals larger but still small and insignificant effects for articles with stronger negative and positive coverage, and in rural compared to urban areas. The small and insignificant effects provide important information for the functioning of patient choice markets and are in line with earlier findings on the topic, using a different source of information.


The full thesis: Choices among Doctors, Students and Primary Care Providers: Empirical Evidence from Sweden