Publication type: Conference other
Type of review: No review
Title: Cost impact of the changing role of the general practitioner in trauma care : a decomposition analysis
Authors: Höglinger, Marc
et. al: No
Conference details: International Health Economics Association (iHEA) World Congress 2019, Basel, Switzerland, 13-17 July 2019
Issue Date: 2019
Language: English
Subject (DDC): 362: Health and social services
Abstract: Background: General practitioners (GPs) play an essential role in the Swiss health care system as the primary providers of ambulatory physician care. This also holds for trauma care, where GPs provide initial care in most cases. However, the period 2008 - 2014 saw a marked decrease from 60% to 54% in initial care by a GP while there was an increase from 32% to 38% of cases where a hospital emergency department (ED) became the first point of care. Potential reasons for trauma patients being treated increasingly in EDs rather than by GPs include changes in patient behavior; the skill, readiness, and willingness of GPs to treat trauma patients; and a reduction in GP in and out-of-hours availability. Objectives: Various studies have shown that GPs provide trauma and other health care services more cheaply than EDs do, which raises fears that reductions to a GP’s role might increase costs even further. However, the precise impact on trauma care costs of the change in a GP’s role is not known, and our objective is to analyze how overall trauma care costs are affected. Methods: Based on a claims dataset from the largest Swiss accident insurer (N=2.2 million injury cases between 2008 and 2014), we constructed individual treatment sequences to determine when and from whom patients received care. Using a Blinder-Oaxaca decomposition, we separated the total cost per case increase for the period in question into four parts: (a) due to changing injury characteristics, (b) due to a changing patient population, (c) due to a change in initial care provider and in the GP’s role, and (d) an unexplained part. Results: Overall, changes in the initial care provider account for approximately 25% of the overall cost per case increase for trauma patients between 2008 and 2014. As one might expect, the relative impact is higher for injuries of low to moderate severity than those of high severity. Conclusions: Our study lies at the intersection of health services research and health economics and provides insights into how a change in treatment pathways affects health care costs. In addition, we can show the impact of changes in treatment pathways (in particular, the role GPs play) relative to other cost drivers such as changing patient population or general health care cost increases. Our results can be used to inform strategies on the cost-efficient provision of care for (trauma) patients and ways to mitigate cost increases. Limitations: Our analysis is based on a complete claims dataset from the largest Swiss accident insurer, SUVA. While covering a large share of the active working population, our results are not straightforwardly generalizable to the general population. Furthermore, the injuries reported come from self-administered accident forms whose validity and granularity is limited. Consequently, there may be some unobserved heterogeneity we cannot control for in our analysis.
Fulltext version: Published version
License (according to publishing contract): Licence according to publishing contract
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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