Title: Comparing US and Swiss health care spending by diseases : where the money goes in the highest spending countries
Authors : Wieser, Simon
Dieleman, Joseph
Squires, Ellen
Conference details: EuHEA Conference 2018, Maastricht, Netherlands, 11-14 July 2018
Issue Date: 2018
License (according to publishing contract) : Licence according to publishing contract
Type of review: Peer review (abstract)
Language : English
Subject (DDC) : 362: Health and social services
Abstract: Objectives: With over 10,000 USD per year the US and Switzerland have the highest per capita health care spending in the world. They are also among the first countries for which total health care spending has been disaggregated by comparable health conditions. This study explores the main similarities and differences in spending by disease in the US and Switzerland and the factors that may be driving the differences. Methods: We compared two recent studies disaggregating national health care spending by diseases in the US and in Switzerland. Both studies categorized diseases according to the Global Burden of Disease study. Spending was compared over 19 exhaustive and mutually exclusive major diseases. Double counting was avoided by restricting spending to the overall total spending for each type of care. Nationally representative data sources were used to assign spending to diseases (hospital registry data, health insurance claims data, household surveys, etc.). Health care spending was compared in three ways: 1) the proportion of disease-specific spending to total spending, 2) the proportion of each disease-specific spending on each service category, and 3) the spending per prevalent case for each disease. Results: Patterns in spending were dominated by similarities between the two countries. 1) Non-communicable diseases constituted 80 percent of spending in the US and 83 percent in Switzerland. Cardiovascular diseases was the disease category with the most spending in both countries, followed by mental and substance use disorders, musculoskeletal disorders, and injures. The proportion of spending on most other disease groups were of similar magnitude. For example, cancers constituted 6 percent of spending in both the US and in Switzerland. 2) The share of inpatient care spending was higher in Switzerland for most diseases and in particular for mental and substance use disorders and injuries. 3) Spending per prevalent case was similar for most diseases. Four diseases had yearly spending above 10,000 USD in both countries (cirrhosis, congenital anomalies, digestive diseases, and cardiovascular diseases). Discussion: Our research highlights the similarities in health care spending by major diseases in the US and in Switzerland. The ranking of diseases by share in total spending as well as the spending per prevalent case are much alike. Differences in spending by diseases may be due to differences in the disease prevalence (higher for diabetes in the US), in the access to care (better for mental and substance use disorders in Switzerland), and age structure of the population (higher share of elderly in Switzerland). This research highlights the value of granular cross-national health system and health spending comparisons.
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Publication type: Conference other
URI: https://digitalcollection.zhaw.ch/handle/11475/15714
Appears in Collections:Publikationen School of Management and Law

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