Abstract
There is currently little systematic knowledge about the contribution of different factors to the increase in health care spending in high-income countries such as Switzerland. The aim of this paper is to decompose inpatient care costs in the Swiss canton of Zurich by 100 diseases and 42 age/sex groups and to assess the contribution of six factors to the change in aggregate costs between 2013 and 2017. These six factors are population size, age and sex structure, inpatient treated prevalence, utilization in terms of stays per patient, length of stay per case, and costs per treatment day. Using detailed inpatient cost data at the case level, we find that the most important contributor to the change in disease-specific costs was a rise in costs per treatment day. For most conditions, this effect was partly offset by a reduction in the average length of stay. Changes in population size accounted for one third of the total increase, but population structure had only a small positive association with costs. The most expensive cases accounted for the largest part of the increase in costs, but the magnitude of this effect differed across diseases. A better understanding of the factors related to cost changes at the disease level over time is essential for the design of targeted health policies aiming at an affordable health care system.
Highlights
High and rising health care spending dominates the health policy debate in high income countries
Recent changes include the implementation of a DRG-based reimbursement system in 2012, the subsequent structural changes in the service provision as well as the demographic transition which came with changing morbidity patterns. These issues render the inpatient care setting in Switzerland an interesting and relevant case for studying the factors associated with the cost increase at the level of specific diseases
This study aims to quantify the contributions of six factors related to the change in aggregated inpatient care costs in the Canton of Zurich between 2013 and 2017
Summary
High and rising health care spending dominates the health policy debate in high income countries. Recent changes include the implementation of a DRG (diagnosisrelated groups)-based reimbursement system in 2012, the subsequent structural changes in the service provision (mainly the shift from inpatient to outpatient treatments) as well as the demographic transition which came with changing morbidity patterns These issues render the inpatient care setting in Switzerland an interesting and relevant case for studying the factors associated with the cost increase at the level of specific diseases. A listed hospital (which may be owned either publicly or privately) receives reimbursement from the cantons (at least 55% of the costs of each inpatient stay that is covered by the mandatory health insurance scheme), whereas non-listed hospitals are exclusively financed by out-of-pocket spending and supplementary insurance. Total spending for acute inpatient care services increased after the DRG implementation by 4.4% in 2012 and 2013, but the growth slowed down afterwards, with rates between –0.3% (2017) and +2.7% (2015 and 2016) [1]
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