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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: The provision of out-of-hours care and associated costs in an urban area of Switzerland : a cost description study
Authors : Eichler, Klaus
Imhof, Daniel
Chmiel, Corinne
Zoller, Marco
Senn, Oliver
Rosemann, Thomas
Huber, Carola A
DOI : 10.21256/zhaw-4879
Published in : BMC Family Practice
Volume(Issue) : 11
Issue : 1
Pages : 99
Pages to: 107
Issue Date: 2010
Publisher / Ed. Institution : BioMed Central
ISSN: 1471-2296
Language : English
Subjects : General practitioner; Home visit; Ambulatory care; Emergency care; Telephone contact
Subject (DDC) : 362: Health and social services
Abstract: 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.
Fulltext version : Published version
License (according to publishing contract) : CC BY 2.0: Attribution 2.0 Generic
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Appears in Collections:Publikationen School of Management and Law

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