Background: Studies from a broad range of countries have demonstrated the usefulness of disease-specific spending estimates in assessing key health economic questions, such as identifying spending drivers and assessing overall healthcare productivity. However, in Switzerland’s fragmented healthcare system, limited data on diagnoses complicates these efforts. This study breaks down total healthcare spending over a 10-year period from multiple perspectives, providing new insights into health care spending and its drivers. Methods: We decompose total healthcare spending according to Swiss National Health Accounts (NHA) in 2012, 2017 and 2022 by 65 diseases from 20 aggregated disease groups, 19 health services, 6 payer categories, 20 age groups, and patient sex. Given the absence of a nation-wide registry of healthcare service use across services and payers, we combine a multitude of existing data sources to assign spending to diseases. These sources include a hospital inpatient registry, long-term care patient assessments, claims data from health and accident insurance, and drug sales data. In outpatient care, we identify diseases at the individual level based on diagnostic clues in claims data, such as disease-specific medication. The resulting spending estimates are scaled to align with total NHA spending. Results: Per capita health care spending in Switzerland increased from 8’329 Swiss francs (CHF) in 2012 to 10’423 CHF in 2022 (+25.1%). Total healthcare spending increased by 37.4% over the same period. The most expensive aggregated disease group in all years were musculoskeletal disorders, accounting for 11.5% of total spending in 2012 and 2017 and 11.1% in 2022. They were closely followed by mental and substance use disorders (10.7%; 10.3%; 10.2%), and neurological disorders (10.4%; 10.4%; 9.7%). The single most expensive disease was Alzheimer’s and other dementia (4.8 bn CHF in 2022; 5.2% of total spending). The largest increase in spending between 2012 and 2022 was observed for skin and subcutaneous diseases (+74.1%), endocrine diseases (+64.4%), and neoplasms (+47.6%). The increase was only modest for oral disorders (+5.4%). The spending increase was mostly driven by a substantial increase in outpatient spending, for instance accounting for 62.4% of the total spending increase in musculoskeletal disorders. For few disease groups, spending for medication was the most important driver, for example digestive diseases (54.5% of the total increase), endocrine diseases (66.2%), and neoplasms (38.0%). Neurological disorders dominated spending in the elderly, largely due to the high spending in long-term care. Conclusions: Healthcare spending in Switzerland has increased substantially over recent decades. By breaking down total spending by disease, service type, payer, and patient characteristics, we build a framework to better understand the structure of healthcare spending and the drivers behind its increase. Despite the lack of diagnostic coding in many areas of the Swiss healthcare system, we successfully estimated spending across multiple perspectives over a 10-year period. Our findings provide essential inputs for more in-depth analyses of spending drivers and assessments of healthcare system productivity.
Stucki et al. (Tue,) studied this question.