Abstract
Background: There is an ongoing discussion on the further promotion of integrated care models in many healthcare systems. Only a few data, which examine the effect of integrated care models on medical expenditures and quality of care in chronically ill patients, exist.Aims: To investigate the effect of integrated care models on disease-related hospitalisations as a quality indicator and healthcare costs in patients with either diabetes, cardiovascular diseases or respiratory illnesses.Methods: A propensity-matched retrospective cohort study based on a large Swiss health insurance database (2012–2013) was performed for three chronic patient groups (diabetes, cardiovascular diseases, respiratory illnesses), who were enrolled in an integrated care model and compared to individuals in a standard care model. Multivariate regression models were applied to estimate the effect of integrated care models on disease-related hospitalisations and healthcare costs.Results: The matched cohorts included a total of 12,526 patients with diabetes, 71,778 with cardiovascular diseases and 17,498 with respiratory illnesses, in which each one half was enrolled in integrated care models and the other half in standard care models. Diabetes and cardiovascular patients with integrated care models had a significantly lower probability of disease-related hospitalisation compared to those with standard care models (p < 0.01). Healthcare costs were statistically significant lower in all three patient groups with integrated care, but with the highest effect in patients with diabetes (Swiss francs (CHF) –778).Conclusions: Integrated care may provide an effective strategy to improve the quality of care and to reduce healthcare costs in chronically ill patients. Study findings intend to contribute to the ongoing political discussion on integrated care and provide evidence for improved and more effective care of patients with chronic diseases.
Highlights
Switzerland has almost 20 years of experience in the development of integrated care models [1] and provides a wide range of insurance plans
This study aimed to assess the impact of integrated care models on hospital admissions and to determine potential cost reductions from integrated care in patients affected with highly prevalent chronic diseases including diabetes mellitus, cardiovascular diseases and respiratory illnesses
We identified a total of 36,532 patients with diabetes, 186,986 with cardiovascular diseases and 45,364 with respiratory illnesses from source population at baseline
Summary
Switzerland has almost 20 years of experience in the development of integrated care models [1] and provides a wide range of insurance plans. Methods: A propensity-matched retrospective cohort study based on a large Swiss health insurance database (2012–2013) was performed for three chronic patient groups (diabetes, cardiovascular diseases, respiratory illnesses), who were enrolled in an integrated care model and compared to individuals in a standard care model. Results: The matched cohorts included a total of 12,526 patients with diabetes, 71,778 with cardiovascular diseases and 17,498 with respiratory illnesses, in which each one half was enrolled in integrated care models and the other half in standard care models. Conclusions: Integrated care may provide an effective strategy to improve the quality of care and to reduce healthcare costs in chronically ill patients. Study findings intend to contribute to the ongoing political discussion on integrated care and provide evidence for improved and more effective care of patients with chronic diseases
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