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.
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Acknowledgements
We are grateful for the opportunity to use the data on the final cause of death provided by the Swiss Federal Statistical Office. The authors also thank Sonja Wehrle and Mikaël Thomas for their helpful support in coding inpatient treatments and Annette Jamieson for her critical review of the manuscript.
Funding
Helsana Group provided support in the form of salaries for authors [CB, RR, AS, OR, EB] but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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According to the national ethical and legal regulation (article 22 of the Swiss data protection law), ethical approval was not needed, as this study is retrospective and based on anonymized routine administrative healthcare claims data. Furthermore, a formal request was sent to the Ethics committee Kantonale Ethikkommission Zürich in the Canton of Zurich. According to this committee, no further ethics approval was needed as the study falls outside the scope of the Swiss Federal Act on Research involving Human Beings (Human Research Act).
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Bähler, C., Rapold, R., Signorell, A. et al. Regional differences in healthcare costs at the end of life: an observational study using Swiss insurance claims data. Int J Public Health 65, 969–979 (2020). https://doi.org/10.1007/s00038-020-01428-w
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DOI: https://doi.org/10.1007/s00038-020-01428-w