Patients in Switzerland with private health insurance are more likely to receive cardiac treatment than patients with basic health insurance, according to the University of Basel.
Switzerland has one of the most expensive healthcare systems in the world. Everyone in the country access to excellent medical care due to a mandatory health insurance requirement. Patients can also opt for supplementary insurance allowing patients to access additional benefits during inpatient treatment, such as a private room and a choice in which doctor, they use.
Are patients receiving unnecessary treatment?
Health insurance companies finance treatments for basic insurance policyholders with a flat, per-case fee; however, hospitals can charge patients with additional supplementary insurance fees. This benefits the medical staff, but some have speculated that this creates financial incentives to offer unnecessary treatments to supplementary insurance holders.
Researchers from the University of Basel and the Cantonal Hospital of Aarau examined the correlations between differences in cardiovascular interventions and insurance status. The research team analysed data from the Swiss Federal Statistical Office. The data contain information on planned hospital admissions of 590,000 adult patients who received inpatient treatment between 2012 and 2020.
Around 105,000 treatments consisted of eight different cardiovascular interventions. These included the widening of narrowed coronary blood vessels and the implanting of a pacemaker. Of these, 64.4% were paid via basic health insurance.
The researchers analysed this data set, looking for differences that could be related to patients’ health insurance status and could not be justified by other characteristics such as age, gender, comorbidities, or size and type of hospital.
Overall, the researchers found that both basic insurance holders and those with supplementary private insurance underwent an increasing number of interventions over the course of the study. This excluded the first two waves of COVID-19 in 2020.
However, the likelihood of undergoing a cardiovascular intervention was 11% higher in patients with supplementary insurance than in those with basic insurance. This equated to 895 additional interventions per year across Switzerland.
“We observed a disparity in the treatments received by the two groups that cannot be explained by patient characteristics,” said study author Dr Tristan Struja.
“Our data indicate that individuals with supplementary insurance receive treatments that are difficult to justify from a medical perspective and may potentially be unnecessary,” he continued.
Supplementary policyholders should need less treatment
The researchers also found that those with supplementary private insurance are typically better educated, had higher disposable income, were generally healthier, and were admitted to hospital less frequently than people with basic insurance. The researchers emphasised that they would expect these people to require fewer health interventions. They do not believe the reasons for the difference in treatment are clinical.
“We assume that people with supplementary private insurance access medical care more often, in part because they spend more money on their health insurance,” said Professor Philipp Schütz, group leader at the Department of Clinical Research at the University of Basel.
“At the same time, hospitals have clear economic incentives to perform inpatient interventions on this lucrative class of patients instead of skipping them or at least performing them as outpatient procedures,” he added.
The researchers also believe this leads to an inefficient allocation of health services. They have recommended the reconsideration fees for private patients and redesigning incentives that are focused on quality of care.