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Zum Zeitpunkt der Berichterstellung wurde im Parlament die Einführung einer einheitlichen Finanzierung der ambulanten und stationären Leistungen (EFAS) diskutiert. Dabei stellt sich die Frage, inwiefern Pflegeleistungen ebenfalls in EFAS integriert werden sollen. Gleichzeitig verlangt ein Postulat aufzuzeigen, wie die Kostensteigerungen bei den Pflegeleistungen gleichermassen durch alle Finanzierungsträger mitfinanziert werden können. Für beide Vorhaben müssen teilweise die gleichen Grundlagen erarbeitetwerden. Benötigt werden insbesondere: Ein Konzept zur Herstellung von Transparenz über die Kosten der Pflegeleistungen in Abgrenzungder Betreuungsleistungen.Ein Konzept zur Erarbeitung eines einheitlichen Vergütungsmodells unter Einbezug der zukünftigenAusgestaltung der Patientenbeteiligung.Ein Konzept zur Bestimmung der Finanzierungsanteile von Krankenversicherern, Kantonenund Gemeinden sowie der Patienten. Die vorliegende Konzeptstudie gibt im ersten Teil einen Überblick über bereits vorhandene Informationenund zeigt auf, wo Lücken bestehen bzw. welche Grundlagen zur Integration der Pflegeleistungenin EFAS erst noch geschaffen werden müssen. Im zweiten Teil werden Umsetzungsvorschlägefür die drei Konzepte skizziert., + ID der Publikation: hslu_81447 + Art des Beitrages: Bericht + Sprache: Deutsch + Letzte Aktualisierung: 2024-07-30 12:49:10

Diese Studie berechnet zum ersten Mal für die Schweiz die direkten Kosten aller nicht übertragbaren Krankheiten (NCDs) und die direkten und indirekten Kosten von sieben ausgewählten NCD-Gruppen. Die Abgrenzung der NCDs und NCD-Gruppen erfolgt auf der Grundlage des Global-Burden-of-Disease-Projekts der WHO. Die Kostenberechnung erfolgt mit zwei unterschiedlichen Ansätzen: Im datenbasierten Ansatz werden die gesamten Kosten des schweizerischen Gesundheitswesens im Jahr 2011 auf verschiedene Ursachen für die Inanspruchnahme von Gesundheitsleistungen aufgeteilt. Im literaturbasierten Ansatz werden die direkten und indirekten Kosten der sieben ausgewählten NCD-Gruppen auf der Grundlage von schweizerischen und ausländischen Krankheitskostenstudien berechnet. Im Jahr 2011 beträgt gemäss dem datenbasierten Ansatz der Anteil der NCDs 80.0% an den gesamten Gesundheitsausgaben von CHF 64.6 Mrd., mit 51.1% für die sieben ausgewählten NCDs und 28.9% für die übrigen NCDs. Unter den sieben ausgewählten NCDs machen die Kosten der Herz-Kreislauf- und muskuloskelettalen Erkrankungen den grössten Anteil aus, gefolgt von den psychischen Störungen, Krebs, den chronischen Atemwegserkrankungen, Demenz und Diabetes. Die indirekten Kosten der sieben ausgewählten NCD-Gruppen liegen bei ca. CHF 41.1 Mrd. und sind damit ähnlich hoch wie die direkten Kosten im literaturbasierten Ansatz.

In most countries, surprisingly little is known on how national healthcare spending is distributed across diseases. Single-disease cost-of-illness studies cover only a few of the diseases affecting a population and in some cases lead to untenably large estimates. The objective of this study was to decompose healthcare spending in 2011, according to Swiss National Health Accounts, into 21 collectively exhaustive and mutually exclusive major disease categories. Diseases were classified following the Global Burden of Disease Study. We first assigned the expenditures directly mapping from National Health Accounts to the 21 diseases. The remaining expenditures were assigned based on diagnostic codes and clues contained in a variety of microdata sources. Expenditures were dominated by non-communicable diseases with a share of 79.4%. Cardiovascular diseases stood out with 15.6% of total spending, followed by musculoskeletal disorders (13.4%), and mental and substance use disorders (10.6%). Neoplasms (6.0% of the total) ranked only sixth, although they are the leading cause of premature death in Switzerland. These results may be useful for the design of health policies, as they illustrate how healthcare spending is influenced by the epidemiological transition and increasing life expectancy. They also provide a plausibility check for single cost-of-illness studies. Our study may serve as a starting point for further research on the drivers of the constant growth of healthcare spending.

Regulation fostering Managed Care alternatives in health insurance is spreading. This work reports on an experiment designed to measure the amounts of compensation asked by the Swiss population (in terms of reduced premiums) for Managed-Care type restrictions in the provision of health care. It finds that restrictions on the freedom of physician choice would require an average compensation of more than one-third of the premium, while generic substitution even meets with a small willingness to pay. Marked preference heterogeneity is an argument against regulation imposing uniformity of contract in Swiss social health insurance

The impact of aging on healthcare expenditure (HCE) has been at the center of a prolonged debate. This paper purports to shed light on several issues of this debate by presenting new evidence on the "red herring" hypothesis advanced by Zweifel, Felder and Meier (1999). This hypothesis amounts to distinguishing a mortality from a morbidity component in healthcare expenditure (HCE) and claiming that failure to make this distinction results in excessive estimates of future growth of HCE. A re-estimation based on a much larger data set is performed, using the refined econometric methodology. The main contribution is consistency, however. Rather than treating the mortality component as a residual in forecasting, its dynamics are analyzed in the same detail as that of the morbidity component when predicting the impact of population aging on the future growth of HCE. For the case of Switzerland, it finds this impact to be relatively small regardless of whether or not the mortality component is accounted for, thus qualifying the "red herring" hypothesis

The impact of aging on healthcare expenditure (HCE) has been at the center of a prolonged debate. This paper purports to shed light on several issues of this debate by presenting new evidence on the "red herring" hypothesis advanced by Zweifel, Felder and Meier (1999). This hypothesis amounts to distinguishing a mortality from a morbidity component in healthcare expenditure (HCE) and claiming that failure to make this distinction results in excessive estimates of future growth of HCE. A re-estimation based on a much larger data set is performed, using the refined econometric methodology. The main contribution is consistency, however. Rather than treating the mortality component as a residual in forecasting, its dynamics are analyzed in the same detail as that of the morbidity component when predicting the impact of population aging on the future growth of HCE. For the case of Switzerland, it finds this impact to be relatively small regardless of whether or not the mortality component is accounted for, thus qualifying the "red herring" hypothesis.

In the present allocation of resources in healthcare, preferences of consumers as the ultimate financiers of healthcare services are judged to be of little relevance. This state of affairs is being challenged because the past decade has seen great progress in the measurement of preferences, or more precisely, willingness-to-pay (WTP) as applied to healthcare services. This article reports evidence on WTP of the Swiss population with regard to three hypothetical modifications of the drug benefit to be covered by social health insurance: delaying access to the most recent therapeutic innovations (among them, drugs) by two years in exchange for a reduction of the monthly premium; substituting original preparations by generics, again in return for a lowered premium; and the exclusion of preparations for the treatment of minor complaints from the drug benefit. Using discrete-choice experiments, WTP and its determinants are estimated. Average WTP for avoiding such a delay (which acts across the board) is much higher than for eschewing the exclusive use of generics (which are claimed to be largely equivalent to the original) or the retention of 'unimportant' drugs in the list of benefits – a rating predicted by economic theory. In addition, a great deal of preference heterogeneity between the French-speaking minority and the German-speaking majority was found, pointing to considerable efficiency losses caused by uniformity of social health insurance.

The impact of aging on healthcare expenditure (HCE) has been at the center of a prolonged debate. This paper purports to shed light on several issues. First, it presents new evidence on the relative importance of the two components of HCE that have been distinguished by Zweifel, Felder and Meier (1999), viz. the cost of morbidity and the cost of mortality (their "red herring" hypothesis claims that neglecting the mortality component results in excessive estimates of future growth of HCE). Second, it takes account of recent evidence suggesting that HCE does increase life expectancy, implying that time-to-death is an endogenous determinant of HCE. Third, it investigates the contribution of population aging to the future growth of HCE. For the case of Switzerland, it finds this contribution to be relatively small regardless of whether or not the cost of dying is accounted for, thus qualifying the "red herring" hypothesis.

Die Wirksamkeit und Sicherheit der beiden in der Schweiz zur Behandlung der Hepatitis C zugelassenen Kombinationstherapien (Pegasys®/Copegus®, PAC; PegIntron®/Rebetol®, PIR) ist sehr ähnlich. Das Ziel dieser Arbeit ist, die Kosten der beiden Therapien zu vergleichen und ihren kostengünstigsten Einsatz zu definieren. Die Durchschnittskosten für Genotyp-1-Patienten liegen zwischen CHF 21700.- (PAC) und CHF 19700.- (PIR), bzw. CHF 15600.- (PAC) und CHF 15000.- (PIR) für Genotyp-2/3-Patienten. Ein konsequenter Einsatz von PIR ist 9 bis 12% kostengünstiger als PAC. Weitere Kosteneinsparungen von 3% könnten bei einem Einsatz von PIR bei allen Patienten unter 85 kg (Genotyp 1) bzw. unter 75 kg (Genotyp 2/3) und von PAC bei solchen über 85 kg (Genotyp 1) bzw. über 75 kg (Genotyp 2/3) erreicht werden.