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Titel: The provision of out-of-hours care and associated costs in an urban area of Switzerland : a cost description study
Autor/-in: Eichler, Klaus
Imhof, Daniel
Chmiel, Corinne
Zoller, Marco
Senn, Oliver
Rosemann, Thomas
Huber, Carola A
Erschienen in: BMC family practice
Band(Heft): 11
Heft: 1
Seiten: 99
Seiten bis: 107
Verlag / Hrsg. Institution: BioMed Central
Erscheinungsdatum: 2010
Lizenz (gemäss Verlagsvertrag): CC BY 2.0: Namensnennung 2.0 Generic
Art der Begutachtung: Peer review (Publikation)
Sprache: Englisch
Schlagwörter: General practitioner; Home visit; Ambulatory care; Emergency care; Telephone contact
Fachgebiet (DDC): 362: Gesundheits- und Sozialdienste
Zusammenfassung: Background: In Switzerland, General Practitioners (GPs) play an important role for out-of-hours emergency care as one service option beside freely accessible and costly emergency departments of hospitals. The aim of this study was to evaluate the services provided and the economic consequences of a Swiss GP out-of-hours service. Methods: GPs participating in the out-of-hours service in the city of Zurich collected data on medical problems (ICPC coding), mode of contact, mode of resource use and services provided (time units; diagnostics; treatments). From a health care insurance perspective, we assessed the association between total costs and its two components (basic costs: charges for time units and emergency surcharge; individual costs: charges for clinical examination, diagnostics and treatment in the discretion of the GP). Results: 125 GPs collected data on 685 patient contacts. The most prevalent health problems were of respiratory (24%), musculoskeletal (13%) and digestive origin (12%). Home visits (61%) were the most common contact mode, followed by practice (25%) and telephone contacts (14%). 82% of patients could be treated by ambulatory care. In 20% of patients additional technical diagnostics, most often laboratory tests, were used. The mean total costs for one emergency patient contact were €144 (95%-CI: 137-151). The mode of contact was an important determinant of total costs (mean total costs for home visits: €176 [95%-CI: 168-184]; practice contact: €90 [95%-CI: 84-98]; telephone contact: €48 [95%-CI: 40-55]). Basic costs contributed 83% of total costs for home visits and 70% of total costs for practice contacts. Individual mean costs were similarly low for home visits (€30) and practice contacts (€27). Medical problems had no relevant influence on this cost pattern. Conclusions: GPs managed most emergency demand in their out-of-hours service by ambulatory care. They applied little diagnostic testing and basic care. Our findings are of relevance for policy makers even from other countries with different pricing policies. Policy makers should be interested in a reimbursement system promoting out-of-hours care run by GPs as one valuable service option.
Departement: School of Management and Law
Organisationseinheit: Winterthurer Institut für Gesundheitsökonomie (WIG)
Publikationstyp: Beitrag in wissenschaftlicher Zeitschrift
DOI: 10.1186/1471-2296-11-99
10.21256/zhaw-4879
ISSN: 1471-2296
URI: https://digitalcollection.zhaw.ch/handle/11475/12827
Enthalten in den Sammlungen:Publikationen School of Management and Law

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