1 / 11

Medical practice variations in Switzerland

Draft – subject to revisions. Second expert group meeting on medical practice variations. Medical practice variations in Switzerland. Dimitri Kohler, Swiss Health Observatory (SHO) Stefan Otto, Federal Office of Public Health (FOPH) Paris, April 26 th 2013. Objectives and scope.

beatrice-wallace
Download Presentation

Medical practice variations in Switzerland

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Draft – subjecttorevisions Second expert group meeting on medical practice variations Medical practice variations in Switzerland Dimitri Kohler, Swiss Health Observatory (SHO) Stefan Otto, Federal Office of Public Health (FOPH) Paris, April 26th 2013

  2. Objectives and scope • Objectives • Identify intercantonal variations of hospital procedures in Switzerland • Highlight the evolution of hospital procedures over time • Scope • Focus on the interventions from the first priority list (including optional procedures)

  3. Data and method • Data • Swiss statistics of hospital discharges • Swiss statistics of hospitals • Time period • 2005-2011 • Regional units • 25 cantons (AI and AR are pooled together and analyzed as a single canton [AP]) • Population ranging from 1,4mio (ZH) to 35’400 (UR), mean=306’000, median=223’000

  4. Data and method • Inclusion/exclusion criteria • Stationary care • Discharge during the year of analysis • Patients with unknown place of life or living abroad are excluded • Procedures identification • Based on ICD-9-CM (OECD guidelines) • CHOP codes (Swiss codes) • Direct standardization of the rates • Based on age and sex • According to the yearly structure of the Swiss population

  5. Results • The rates of all procedures increased over the period 2005-2011. • Four main profiles (preliminary results) • Low increase • Coronary bypass, CABG + 0,2% • Hospital medical admissions +7,4% • Moderate increase • Knee arthroscopy +13,6% • Caesarean sections +14,1% • High increase • Coronary Catheterisation +20,9% • Coronary angioplasty, PTCA +22,3% • Admission after hip fracture +28,8% • Veryhighincrease • Knee replacement +41,7%

  6. Results Trends in medical practice variations

  7. Results • Coefficients of variation in 2011 • Three main groups identified (preliminary results)

  8. Results • The calibration procedure (Admission after hip fracture) • Gap between 90e and 10e percentile is relatively small and stable until 2009 • Unexplained increase of the 90th percentile between 2009 and 2010 • 8 cantons over 30% increase • CV important increase :

  9. Limitations and discussion • Limitations • Variable proportion of ambulatory interventions for • Knee arthroscopy (31%) • Catheterisation (22%) • PTCA (13%) • Data coverage of ambulatory interventions (Tarifpool, SASIS SA) between 50% and 80% • Ranking of cantons is pretty unstable • Discussion • Evidence of substitution patterns (CABG) • General convergence of the different practices

  10. Conclusions (1) • The cantons are responsible for policy / planning but causes of praxis variations seems not to be related to these factor today • The variations within cantons are bigger than between cantons • A study (2012) concerning the cesarean section showed a complex cause and effect relationship; the appraisal of policy options was very difficult • For the detection of causes, smaller areas (urban, rural, hospital catchment areas, …) and procedure specific factors has to be analyzed • The country-differences of the health care systems (and the data-differences) affords country-specific analyzes

  11. Thank you for your attention! • Contact details • dimitri.kohler@bfs.admin.ch • sonia.pellegrini@bfs.admin.ch • stefan.otto@bag.admin.ch

More Related