medical practice variations in switzerland

Espace de l‘Europe 10CH-2010 Neuchâtel

[email protected]

Medical practice variations in Switzerland

Dimitri Kohler, Swiss Health Observatory (SHO)Stefan Otto, Federal Office of Public Health (FOPH) Paris, April 26th 2013

Second expert group meeting on medical practice variations

Draft – subject to revisions

Dimitri Kohler, Stefan Otto, Medical practice variations in Switzerland, Paris, April 26th 2013

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)

Objectives and scope


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

Data and method


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


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%

Very high increase• Knee replacement +41,7%


Results

Trends in medical practice variations


Coefficients of variation in 2011 Three main groups identified (preliminary results)

Groups Procedures CV

Low variations Hospital medical admissions, PTCA, knee replacement, caesarean section [13,5 ; 16,9]

Moderate variations CABG, catheterisation [26,0 ; 26,9]

High variations Knee arthroscopy 49,4

Calibration procedure Admissions after hip fracture 20,4

Results


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 :

4,20

8,14

2011

20092005

CV

CV

0

50

100

150

200

250

2005 2006 2007 2008 2009 2010 2011

90e Percentile

Moyenne

10e Percentile

Ecart-type

Taux

de

reco

urs s

tand

ardi

sés

(pou

r 100

000

habi

tant

s)


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

Limitations and discussion


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

Conclusions (1)


Thank you for your attention!

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medical practice variations in switzerland

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