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03 What factors affect the performance of elective interventions in Switzerland?

 

Various factors determine whether non-vital medical interventions – referred to as elective interventions – are performed or not. The study will investigate regional and temporal variations affecting elective interventions in Switzerland and will look for possible explanations.

Portrait / project description (ongoing research project)

Medical hospital statistics and epidemiological methods will be used to create Swiss hospital regions. A statistical analysis will then be performed to see how the rates of 15 elective interventions differ on a regional basis and over time. Recent/controversial interventions such as closure of the aperture between the right and left upper chambers of the heart following a stroke will also be included. These data will be linked to other hospital data and data from the Swiss Medical Society. Regression models will be used to investigate the influence of socio-economic, health-related, regional and supply-driven factors on regional differences in the performance of elective interventions. Major differences, particularly with respect to controversial interventions, may point to overuse.

Background

About 25 per cent of health-related costs are incurred by treatments for which there are alternatives and which are therefore not vital. Regional differences in the performance of elective interventions – including, for example, injections of cement into fractures of the vertebrae, knee and hip replacements and certain invasive procedures involving the heart – suggest that not only medical necessity but also the patient’s wishes and the doctor’s personal preferences affect the decision to intervene. The introduction of flat-rate payments per case in Switzerland provides an opportunity to study regional differences in in-patient interventions using high-quality data.

Aim

The aim of the study is to use flat rate per case data to identify regional and temporal differences in the performance of inpatient elective interventions in Switzerland and to explain any differences.

Relevance / application

The study will document trends and regional differences in elective medical interventions and identify the causes of these differences. This knowledge will help to develop measures that can be adopted by the health authorities, healthcare professionals and patients in order to reduce the frequency of potentially unnecessary interventions. The data will additionally form the basis for a future Swiss health atlas that will enable trends in healthcare to be followed.

Original title

Variations in preference-sensitive care and controversial medical procedures in Switzerland

Project Leaders

Applicant:

  • Prof. Dr. med. Drahomir Aujesky, MSc, Universitätsklinik und Poliklinik für Allgemeine Innere Medizin, Inselspital, Universitätsspital Bern

Co-applicants:

  • Dr. Radoslaw Panczak, Institut für Sozial und Präventivmedizin, Universität Bern
  • Dr. Maria Wertli, Klinik für Allgemeine Innere Medizin, Inselspital, Universitätsspital Bern
  • Prof. Nicolas Rodondi, Berner Institut für Hausarztmedizin (BIHAM), Universität Bern
  • Dr. Claudia Scheuter, Klinik für Allgemeine Innere Medizin, Inselspital, Universitätsspital Bern
  • Dr. Arnaud Chiolero, Division des maladies chroniques (DMC), Institut Universitaire de Médecine Sociale et Préventive (IUMSP), Université de Lausanne

 

 

Further information on this content

 Contact

Prof. Dr. med. Drahomir Aujesky Klinikdirektor und Chefarzt
Universitätsklinik und Poliklinik für Allgemeine Innere Medizin PKT 2 D562
Inselspital
Universitätsspital Bern
3010 Bern +41 31 632 88 84 drahomir.aujesky@insel.ch

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