An evaluation of the 2019 reform to shift interventions from hospital to outpatients settings has shown positive effects in terms of reduced numbers of inpatient treatments.
Since early 2019, the costs of
six groups of interventions are only reimbursed by the health insurance
funds if they are performed on an outpatient basis (see Analyses: https://eurohealthobservatory.who.int/monitors/health-systems-monitor/analyses/hspm/switzerland-2015/outpatient-care-takes-precedence-over-inpatient-care-six-groups-of-surgical-interventions-to-be-moved-to-outpatient-care).
Justified cases are exempt from this regulation, and in the case of
non-covered circumstances, inpatient treatment is only possible after
prior approval of costs by the insurer. The six groups of interventions
are:
- Unilateral varicose vein surgery of the legs
- Haemorrhoid procedures
- Unilateral inguinal hernia surgery
- Examinations/interventions on the cervix or uterus
- Knee arthroscopy, including arthroscopic surgery on the meniscus
- Tonsil and adenoid surgery
The 2019 reform has shown to be effective both in terms of volume and price.
On
behalf of the FOPH, the Swiss Health Observatory has been monitoring in
the first three years the actual effects of this regulation, in terms
of number of outpatient and inpatient interventions, costs, quality of
treatment and administrative processes
for billing and auditing. Results show that number of inpatient
surgeries compared to the population and the corresponding costs have
declined more sharply since 2019 than in previous years. Depending on
the group of procedures, this decline in volume
varied: it ranges from 17% for knee arthroscopies to 48% for
haemorrhoid procedures. Correspondingly, the rate of outpatient
operations has increased in most cases.
It is not possible to analyse the effects on the quality of treatment with the routinely collected statistical data. A final evaluation will be carried out based on the results from the monitoring and the study. Based on the results of this evaluation, a decision will be made as to whether and how the “outpatient before inpatient” regulation will be expanded or adapted.