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Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

INTRODUCTION: In Switzerland, a nationwide Swiss Diagnosis related Groups (Swiss DRG) system for hospital reimbursement was introduced in 2012. However, the impact of DRG systems on primary care is still unclear with respect to number of consultations and costs. The aim of this study was to investig...

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Autores principales: Al-Khalil, Omar, Valeri, Fabio, Senn, Oliver, Rosemann, Thomas, Di Gangi, Stefania
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591068/
https://www.ncbi.nlm.nih.gov/pubmed/33108373
http://dx.doi.org/10.1371/journal.pone.0241179
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author Al-Khalil, Omar
Valeri, Fabio
Senn, Oliver
Rosemann, Thomas
Di Gangi, Stefania
author_facet Al-Khalil, Omar
Valeri, Fabio
Senn, Oliver
Rosemann, Thomas
Di Gangi, Stefania
author_sort Al-Khalil, Omar
collection PubMed
description INTRODUCTION: In Switzerland, a nationwide Swiss Diagnosis related Groups (Swiss DRG) system for hospital reimbursement was introduced in 2012. However, the impact of DRG systems on primary care is still unclear with respect to number of consultations and costs. The aim of this study was to investigate the effect of the implementation of DRG on costs and volumes in the primary care sector, on a nationwide basis in Switzerland. METHODS: The study retrospectively analysed yearly data, from 2008 to 2014, of almost 60 Swiss health insurers that covered almost all Swiss general practitioners, with a total number of patients which represented approximately 76% of the Swiss population. GP consultations, total numbers and rates, and the relative costs reimbursed (TARMED tariff values) in the Swiss federal states, cantons, which already introduced a DRG-like system before 2012 (AP-DRG), were compared to the GP consultations and costs reimbursed in the other cantons (DRG-naive). Regression discontinuity design analysis and mixed regression models, at cantonal level, were performed to evaluate the effect of the nationwide implementation of the Swiss DRG on health care demand and costs in the primary care setting. Change in outcome level and yearly trend pattern difference between groups (AP-DRG vs. DRG-naive) were examined. RESULTS: Overall, the total number of GP consultations and the relative TARMED values increased from 2008 to 2014. In the DRG naive, 15 cantons: in 2008, the number of GP consultations were 13,114,126, with a TARMED value of 1,194,957,157 CHF, and in 2014, the GP consultation were 13,752,511, with a TARMED value of 1,513,861,260 CHF. In the AP-DRG group, 11 cantons, the total number of GP consultations increased from 8,787,646, in 2008, to 9,347,168 in 2014 and the TARMED value increased from 896,673,657 CHF in 2008, to 1,100,203,508 CHF in 2014. The yearly trend pattern of GP consultations and TARMED values, in the AP-DRG group, were not significantly different from the respective trends in the DRG- naive and, overall, no significant change was detected in consultations and costs trends before and after 2012. DISCUSSION/CONCLUSION: This study found no evidence of any effect of the introduction of the SwissDRG on the yearly trend of primary care consultations and costs. Nevertheless, potential negative impacts on vulnerable patients, as chronically ill patients, could not be excluded and further investigation is required.
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spelling pubmed-75910682020-10-30 Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis Al-Khalil, Omar Valeri, Fabio Senn, Oliver Rosemann, Thomas Di Gangi, Stefania PLoS One Research Article INTRODUCTION: In Switzerland, a nationwide Swiss Diagnosis related Groups (Swiss DRG) system for hospital reimbursement was introduced in 2012. However, the impact of DRG systems on primary care is still unclear with respect to number of consultations and costs. The aim of this study was to investigate the effect of the implementation of DRG on costs and volumes in the primary care sector, on a nationwide basis in Switzerland. METHODS: The study retrospectively analysed yearly data, from 2008 to 2014, of almost 60 Swiss health insurers that covered almost all Swiss general practitioners, with a total number of patients which represented approximately 76% of the Swiss population. GP consultations, total numbers and rates, and the relative costs reimbursed (TARMED tariff values) in the Swiss federal states, cantons, which already introduced a DRG-like system before 2012 (AP-DRG), were compared to the GP consultations and costs reimbursed in the other cantons (DRG-naive). Regression discontinuity design analysis and mixed regression models, at cantonal level, were performed to evaluate the effect of the nationwide implementation of the Swiss DRG on health care demand and costs in the primary care setting. Change in outcome level and yearly trend pattern difference between groups (AP-DRG vs. DRG-naive) were examined. RESULTS: Overall, the total number of GP consultations and the relative TARMED values increased from 2008 to 2014. In the DRG naive, 15 cantons: in 2008, the number of GP consultations were 13,114,126, with a TARMED value of 1,194,957,157 CHF, and in 2014, the GP consultation were 13,752,511, with a TARMED value of 1,513,861,260 CHF. In the AP-DRG group, 11 cantons, the total number of GP consultations increased from 8,787,646, in 2008, to 9,347,168 in 2014 and the TARMED value increased from 896,673,657 CHF in 2008, to 1,100,203,508 CHF in 2014. The yearly trend pattern of GP consultations and TARMED values, in the AP-DRG group, were not significantly different from the respective trends in the DRG- naive and, overall, no significant change was detected in consultations and costs trends before and after 2012. DISCUSSION/CONCLUSION: This study found no evidence of any effect of the introduction of the SwissDRG on the yearly trend of primary care consultations and costs. Nevertheless, potential negative impacts on vulnerable patients, as chronically ill patients, could not be excluded and further investigation is required. Public Library of Science 2020-10-27 /pmc/articles/PMC7591068/ /pubmed/33108373 http://dx.doi.org/10.1371/journal.pone.0241179 Text en © 2020 Al-Khalil et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Al-Khalil, Omar
Valeri, Fabio
Senn, Oliver
Rosemann, Thomas
Di Gangi, Stefania
Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis
title Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis
title_full Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis
title_fullStr Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis
title_full_unstemmed Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis
title_short Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis
title_sort effects of a drg-based hospital reimbursement on the health care utilization and costs in swiss primary care: a retrospective “quasi-experimental” analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591068/
https://www.ncbi.nlm.nih.gov/pubmed/33108373
http://dx.doi.org/10.1371/journal.pone.0241179
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