Key result
Cantonal legislations directing patients to outpatient settings significantly decreased the proportion of inpatient procedures (effect size 0.57; 95% CI 0.51-0.64; p<0.001) without increasing costs.
Why the study?
The real-world effects of Swiss cantonal legislations directing surgical patients from the inpatient to outpatient setting had not been examined.
Does cantonal legislation directing surgery patients to outpatient settings reduce inpatient procedures and healthcare costs without increasing follow-up costs or hospitalizations in adult surgery patients?
Observational (n=38,475)
Yes
Does cantonal legislation directing surgery patients to outpatient settings reduce inpatient procedures and healthcare costs without increasing follow-up costs or hospitalizations in adult surgery patients?
Cantonal legislations successfully shifted surgical procedures from inpatient to outpatient settings, reducing index costs without negatively impacting follow-up costs or hospitalizations.
Supports legislative shifts to outpatient surgery without added costs; extends observational data but leaves open causal confirmation in other systems.
OBJECTIVE: We examined real-world effects of cantonal legislations to direct surgery patients from the inpatient to the outpatient setting in Switzerland. METHODS: Analyses were based on claims data of the Helsana Group, a leading Swiss health insurance. The study population consisted of 13'145 (in 2014), 12'455 (in 2016), and 12'875 (in 2018) insured persons aged >18 years who had haemorrhoidectomy, inguinal hernia repair, varicose vein surgery, knee arthroscopy/meniscectomy or surgery of the cervix/uterus. We assessed the proportion of inpatient procedures, index costs, length of hospital stays, outpatient costs and hospitalizations during follow-up, stratified by procedure, in-/outpatient setting, and the presence (enacted/effective in 2018) of a cantonal legislation. We used difference-in-differences methods to study the impact of cantonal legislations. RESULTS: Overall, the proportion of procedures performed in the inpatient setting decreased between 2014 and 2018 (p < 0.001). The decrease between 2016 and 2018 was significantly steeper in cantons with a legislation (p < 0.001; effect size: 0.57; 95% CI: 0.51, 0.64), leading to steeper decreases in healthcare costs of index procedures in cantons with a legislation, with no impact on length of hospital stays. The legislation also had no impact on outpatient costs or hospitalizations during follow-up. CONCLUSIONS: The cantonal legislations achieved the intended effects of inpatient surgery substitution by outpatient surgery, with no evidence suggesting negative effects on costs or hospitalizations during follow-up.
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Brüngger et al. (2021) conducted an observational in Elective surgeries (haemorrhoidectomy, inguinal hernia repair, varicose vein surgery, knee arthroscopy/meniscectomy, surgery of the cervix/uterus) (n=38,475). Cantonal legislations to direct surgery patients to the outpatient setting vs. Cantons without such legislation was evaluated on Proportion of inpatient procedures (Effect size 0.57, 95% CI 0.51, 0.64, p=< 0.001). Cantonal legislations directing patients to outpatient settings significantly decreased the proportion of inpatient procedures (effect size 0.57; 95% CI 0.51-0.64; p<0.001) without increasing costs.
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