Economic evaluation of the Austrian telephone-based triage system

Abstract

Abstract Background In order to reduce avoidable consultations but also avoidable self-referrals to hospital outpatient departments, the Austrian authorities agreed to establish a voluntary telephone-based triage system in the course of the health reform 2013. Three regions piloted the system in early 2017. Methods An economic evaluation aimed to assess the impact on health service demand after having consulted the telephone-based system. For analysing the impact, we used the conceptual model of “shift cases” from one particular service setting such as outpatient clinic to another (e.g. GP office) and calculated savings realised through patient shifts. Based on potential savings in private and public costs and running costs of the service, we identified threshold values for cost-effective operation. Results In total, approximately 45,000 completed telephone consultations were registered in the pilot phase. 2,500 persons were advised to conduct self-care whereas more than 40,000 were recommended to contact a health service provider with differing levels of priority. Adherence to the initial recommendation of the provider setting was 70%, the level of priority was met in 90%. With regard to the economic impact, public savings of shift cases range from €31 (self-care instead of GP consultation) to €198 (GP/specialist instead of hospital outpatient clinic). Public costs ranged between €10 and €50 depending on the degree of capacity utilisation, contingency costs and duration of calls. Therefore, economic net gains can be realized if approximately 15% to 25% of callers choose a lower care setting due to the consultation service. Conclusions The tele-triage service has shown to be a potentially cost effective tool but largely depends on user uptake, patient adherence and local maintaining costs. In order to exploit the full potential of the system, policy makers are advised to promote the use of the system in general and to evaluate the used algorithm. Key messages Telephone-based triage systems are a potentially cost-effective strategy in order to reduce avoidable encounters both on a primary care level but also at hospital outpatient clinics. The public savings of a shift in the provider setting vary substantially depending on the level of service delivery with diminishing savings for shifts in lower levels.