Caroline Bähler1, Roland Rapold2, Andri Signorell2, Oliver Reich2, Radoslaw Panczak3, Eva Blozik2,4. 1. Department of Health Sciences, Helsana Insurance Group, Zurich, Switzerland. caroline.baehler-baumgartner@helsana.ch. 2. Department of Health Sciences, Helsana Insurance Group, Zurich, Switzerland. 3. Queensland Centre for Population Research, School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia. 4. Department of Medicine, University Medical Centre Freiburg, Freiburg Im Breisgau, Germany.
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, ≥ 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.
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, ≥ 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.
Entities:
Keywords:
Cause of death; Claims data; End-of-life care; Health care costs; Intensity of treatment; Regional variation
Authors: Aleksander Krasowski; Joachim Krois; Sebastian Paris; Adelheid Kuhlmey; Hendrik Meyer-Lueckel; Falk Schwendicke Journal: Int J Environ Res Public Health Date: 2021-06-21 Impact factor: 3.390