Regional differences in healthcare costs at the end of life: an observational study using Swiss insurance claims data
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ORIGINAL ARTICLE
Regional differences in healthcare costs at the end of life: an observational study using Swiss insurance claims data Caroline Ba¨hler1 Eva Blozik1,3
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Roland Rapold1 • Andri Signorell1 • Oliver Reich1 • Radoslaw Panczak2
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Received: 3 March 2020 / Revised: 11 June 2020 / Accepted: 6 July 2020 / Published online: 15 July 2020 Swiss School of Public Health (SSPH+) 2020
Abstract Objectives We evaluated healthcare cost differences at the end of life (EOL) between language regions in Switzerland, accounting for a comprehensive set of variables, including treatment intensity. Methods We evaluated 9716 elderly who died in 2014 and were insured at Helsana Group, with data on final cause of death provided by the Swiss Federal Statistical Office. EOL healthcare costs and utilization, C 1 ICU admission and 10 life-sustaining interventions (cardiac catheterization, cardiac assistance device implantation, pulmonary artery wedge monitoring, cardiopulmonary resuscitation, gastrostomy, blood transfusion, dialysis, mechanical ventilation, intravenous antibiotics, cancer chemotherapies) reimbursed by compulsory insurance were examined. Results Taking into consideration numerous variables, relative cost differences decreased from 1.27 (95% CI 1.19–1.34) to 1.06 (CI 1.02–1.11) between the French- and German-speaking regions, and from 1.12 (CI 1.03–1.22) to 1.08 (CI 1.02–1.14) between the Italian- and German-speaking regions, but standardized costs still differed. Contrary to individual factors, density of home-care nurses, treatment intensity, and length of inpatient stay explain a substantial part of these differences. Conclusions Both supply factors and health-service provision at the EOL vary between Swiss language regions and explain a substantial proportion of cost differences. Keywords End-of-life care Health care costs Cause of death Regional variation Claims data Intensity of treatment
Introduction As the population ages and number of patients with at least one chronic disease grows, end-of-life (EOL) care is becoming increasingly important. Population aging is
& Caroline Ba¨hler [email protected] Roland Rapold [email protected] Andri Signorell [email protected] Oliver Reich [email protected]
associated with increased demand for intensive care among elderly patients (Flaatten et al. 2017). Yet, previous research has shown that treatments and costs at the EOL vary widely between regions, internationally (Hanchate et al. 2009; Sprung et al. 2003) and in Switzerland, where
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Department of Health Sciences, Helsana Insurance Group, Zurich, Switzerland
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Queensland Centre for Population Research, School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
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Department of Medicine, University Medical Centre Freiburg, Freiburg Im Breisgau, Germany
Radoslaw Panczak [email protected] Eva Blozik [email protected]
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considerable variations exist between language regions (Ba¨hler et al. 2016; Busato and Ku¨
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