{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T22:02:07Z","timestamp":1790373727854,"version":"4.1.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":52,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish National Board of Health and Welfare","award":["S2019\/00910\/FS"],"award-info":[{"award-number":["S2019\/00910\/FS"]}],"id":[{"id":"https:\/\/ror.org\/01v4pc162","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Inequalities in early childhood health persist across high-income countries, and structured home visiting is a principal policy response. Because such programmes are jointly produced by health and social services financed from separate budgets, the authority that pays is often not the authority that saves. We estimated the annual public-sector cost of scaling Sweden\u2019s extended home visiting programme nationally, and how it distributes between regional healthcare and municipal social services. A scenario-based costing analysis from a public-payer perspective. National registers gave an annual target population of 14\u00a0349 families. Unit costs came from micro-costing four pilot sites in disadvantaged areas in 2021. Three scenarios were modelled: a National Standard base case, a Facility-Based Adaptation, and an Enhanced Pilot. Costs are in 2023 Euros. Unit cost per family ranged from EUR 512 (Facility-Based) to EUR 1128 (Enhanced Pilot). Scaling the National Standard model would cost EUR 8.31 million annually, the Enhanced Pilot EUR 11.33 million. Regional healthcare carried 70%\u201376% of costs under every delivery model, because coordination, supervision, and training are overwhelmingly nurse and midwife time. Implementation choices change total cost but not its distribution between payers. Moving contacts from the home to a facility halves the cost and removes the setting through which the programme is theorized to reach marginalized families, without rebalancing the burden. Because the asymmetry follows from how the programme is staffed, scale-up requires explicit cross-sectoral financing agreements wherever health and social care budgets are held separately.<\/jats:p>","DOI":"10.1093\/eurpub\/ckag174","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T11:42:38Z","timestamp":1789213358000},"source":"Crossref","is-referenced-by-count":0,"title":["Scaling an equity-oriented extended home visiting programme in Sweden: costs and cross-sectoral fiscal distribution"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8700-1089","authenticated-orcid":false,"given":"Sergio","family":"Flores","sequence":"first","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University , Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4835-9325","authenticated-orcid":false,"given":"Gunilla","family":"L\u00f6nnberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University , Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6594-2291","authenticated-orcid":false,"given":"Anna","family":"Sarkadi","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University , Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Brunnberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University , Uppsala,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5540-9853","authenticated-orcid":false,"given":"Filipa","family":"Sampaio","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Uppsala University , Uppsala,","place":["Sweden"]},{"name":"Department of Women\u2019s and Children\u2019s Health, Uppsala University , Uppsala,","place":["Sweden"]},{"name":"Department of Learning, Informatics, Management and Ethics, Karolinska Institute , Stockholm,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"2026092517562171700_ckag174-B1","doi-asserted-by":"publisher","first-page":"2147294","DOI":"10.1080\/16549716.2022.2147294","article-title":"Social inequalities in social-emotional problems among preschool children: a population-based study in Sweden","volume":"16","author":"Vaezghasemi","year":"2023","journal-title":"Glob Health Action"},{"key":"2026092517562171700_ckag174-B2","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/S0140-6736(15)00392-X","article-title":"Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial","volume":"387","author":"Robling","year":"2016","journal-title":"Lancet"},{"key":"2026092517562171700_ckag174-B3","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1001\/jamapediatrics.2025.1600","article-title":"Intensive nurse home visiting and early childhood outcomes: a randomized clinical trial","volume":"179","author":"Swanson","year":"2025","journal-title":"JAMA Pediatr"},{"key":"2026092517562171700_ckag174-B4","doi-asserted-by":"publisher","first-page":"105021","DOI":"10.1016\/j.chiabu.2021.105021","article-title":"The effects of home visiting on mother-child interactions: evidence from a randomized trial using dynamic micro-level data","volume":"115","author":"Conti","year":"2021","journal-title":"Child Abuse Negl"},{"key":"2026092517562171700_ckag174-B5","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.3368\/jhr.0321-11557r1","article-title":"Can early intervention have a sustained effect on human capital?","volume":"59","author":"Doyle","year":"2024","journal-title":"J Hum Resour"},{"key":"2026092517562171700_ckag174-B6","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s12889-015-1350-0","article-title":"Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia","volume":"15","author":"Pinto","year":"2015","journal-title":"BMC Public Health"},{"key":"2026092517562171700_ckag174-B7","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2026-225934","article-title":"How are proportionate universalist services affected by resource constraint in practice? Exploring implementation challenges using a synthesis of four health visiting studies in England","author":"Lamont","year":"2026","journal-title":"J Epidemiol Community Health"},{"key":"2026092517562171700_ckag174-B8","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1007\/s10654-025-01226-9","article-title":"The healthcare system in Sweden","volume":"40","author":"Ludvigsson","year":"2025","journal-title":"Eur J Epidemiol"},{"key":"2026092517562171700_ckag174-B9","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1111\/apa.15176","article-title":"Healthcare utilisation and measles, mumps and rubella vaccination rates among children with an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden - a 3-year follow-up","volume":"109","author":"Burstr\u00f6m","year":"2020","journal-title":"Acta Paediatr"},{"key":"2026092517562171700_ckag174-B10","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.pedhc.2023.01.005","article-title":"Changes in comprehensive health literacy among first-time parents attending extended home visiting in Swedish multicultural settings: a case-comparison study","volume":"37","author":"Mekhail","year":"2023","journal-title":"J Pediatr Health Care"},{"key":"2026092517562171700_ckag174-B11","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1111\/scs.13292","article-title":"Parents\u2019 comprehensive health literacy and child health after attending extended home visiting in Swedish multicultural settings - a case-comparison study","volume":"38","author":"Mekhail","year":"2024","journal-title":"Scand J Caring Sci"},{"key":"2026092517562171700_ckag174-B12","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12939-018-0756-6","article-title":"A better start for health equity? Qualitative content analysis of implementation of extended postnatal home visiting in a disadvantaged area in Sweden","volume":"17","author":"Marttila","year":"2018","journal-title":"Int J Equity Health"},{"key":"2026092517562171700_ckag174-B13","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s13104-025-07623-3","article-title":"Building trust in the social services through collaboration between child healthcare nurses and parental supporters from the social services, within an extended home-visit programme: a qualitative study","volume":"19","author":"Hjortsj\u00f6","year":"2025","journal-title":"BMC Res Notes"},{"key":"2026092517562171700_ckag174-B14","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-026-14092-2","article-title":"Toward better home visits: a mixed-methods study identifying disparities in early childhood program delivery to promote health equity","volume":"26","author":"Barboza","year":"2026","journal-title":"BMC Health Serv Res"},{"key":"2026092517562171700_ckag174-B15","first-page":"47","volume-title":"SOU","year":"2017"},{"key":"2026092517562171700_ckag174-B16"},{"key":"2026092517562171700_ckag174-B17","author":"National Board of Health and Welfare","year":"2026"},{"key":"2026092517562171700_ckag174-B18","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1186\/s12889-022-13492-3","article-title":"Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden","volume":"22","author":"Barboza","year":"2022","journal-title":"BMC Public Health"},{"key":"2026092517562171700_ckag174-B19","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/s13012-015-0301-6","article-title":"Narrative review of models and success factors for scaling up public health interventions","volume":"10","author":"Milat","year":"2015","journal-title":"Implement Sci"},{"key":"2026092517562171700_ckag174-B20","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1332\/174426410X482999","article-title":"A web-based tool for adjusting costs to a specific target currency and price year","volume":"6","author":"Shemilt","year":"2010","journal-title":"Evid Policy"},{"key":"2026092517562171700_ckag174-B21","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-026-02867-2","article-title":"Targeting equity in early childhood: resource allocation in Sweden\u2019s extended home visiting program","volume":"25","author":"Flores","year":"2026","journal-title":"Int J Equity Health"},{"key":"2026092517562171700_ckag174-B22","doi-asserted-by":"publisher","first-page":"1640","DOI":"10.12688\/f1000research.20149.1","article-title":"Costs and consequences of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial","volume":"8","author":"Bell","year":"2019","journal-title":"F1000Res"},{"key":"2026092517562171700_ckag174-B23","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s10935-015-0406-3","article-title":"Nurse-Family Partnership: comparing costs per family in randomized trials versus scale-up","volume":"36","author":"Miller","year":"2015","journal-title":"J Prim Prev"},{"key":"2026092517562171700_ckag174-B24","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1111\/apa.70382","article-title":"Clinic versus home: nurses\u2019 and social workers\u2019 perceptions of extended home visits","volume":"115","author":"Wennergren","year":"2026","journal-title":"Acta Paediatr"}],"container-title":["European Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag174\/71398967\/ckag174.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag174\/71398967\/ckag174.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:56:27Z","timestamp":1790373387000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurpub\/article\/doi\/10.1093\/eurpub\/ckag174\/8836180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":24,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/eurpub\/ckag174","relation":{},"ISSN":["1101-1262","1464-360X"],"issn-type":[{"value":"1101-1262","type":"print"},{"value":"1464-360X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,4]]},"article-number":"ckag174"}}