Mehra Tarun, Moos Rudolf M, Seifert Burkhardt, Bopp Matthias, Senn Oliver, Simmen Hans-Peter, Neuhaus Valentin, Ciritsis Bernhard
Medical Directorate, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.
Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
Arch Osteoporos. 2017 Dec;12(1):7. doi: 10.1007/s11657-016-0302-3. Epub 2016 Dec 24.
The assessment of structural and potentially economic factors determining cost, treatment type, and inpatient mortality of traumatic hip fractures are important health policy issues. We showed that insurance status and treatment in university hospitals were significantly associated with treatment type (i.e., primary hip replacement), cost, and lower inpatient mortality respectively.
The purpose of this study was to determine the influence of the structural level of hospital care and patient insurance type on treatment, hospitalization cost, and inpatient mortality in cases with traumatic hip fractures in Switzerland.
The Swiss national medical statistic 2011-2012 was screened for adults with hip fracture as primary diagnosis. Gender, age, insurance type, year of discharge, hospital infrastructure level, length-of-stay, case weight, reason for discharge, and all coded diagnoses and procedures were extracted. Descriptive statistics and multivariate logistic regression with treatment by primary hip replacement as well as inpatient mortality as dependent variables were performed.
We obtained 24,678 inpatient case records from the medical statistic. Hospitalization costs were calculated from a second dataset, the Swiss national cost statistic (7528 cases with hip fractures, discharged in 2012). Average inpatient costs per case were the highest for discharges from university hospitals (US$21,471, SD US$17,015) and the lowest in basic coverage hospitals (US$18,291, SD US$12,635). Controlling for other variables, higher costs for hip fracture treatment at university hospitals were significant in multivariate regression (p < 0.001). University hospitals had a lower inpatient mortality rate than full and basic care providers (2.8% vs. both 4.0%); results confirmed in our multivariate logistic regression analysis (odds ratio (OR) 1.434, 95% CI 1.127-1.824 and OR 1.459, 95% confidence interval (CI) 1.139-1.870 for full and basic coverage hospitals vs. university hospitals respectively). The proportion of privately insured varied between 16.0% in university hospitals and 38.9% in specialized hospitals. Private insurance had an OR of 1.419 (95% CI 1.306-1.542) in predicting treatment of a hip fracture with primary hip replacement.
The seeming importance of insurance type on hip fracture treatment and the large inequity in the distribution of privately insured between provider types would be worth a closer look by the regulatory authorities. Better outcomes, i.e., lower mortality rates for hip fracture treatment in hospitals with a higher structural care level advocate centralization of care.
评估决定创伤性髋部骨折成本、治疗类型和住院死亡率的结构因素及潜在经济因素是重要的卫生政策问题。我们发现，保险状况和在大学医院接受治疗分别与治疗类型（即初次髋关节置换）、成本及较低的住院死亡率显著相关。
本研究旨在确定瑞士医院护理结构水平和患者保险类型对创伤性髋部骨折患者的治疗、住院成本及住院死亡率的影响。
筛查2011 - 2012年瑞士国家医学统计数据，选取以髋部骨折为主要诊断的成年人。提取性别、年龄、保险类型、出院年份、医院基础设施水平、住院时长、病例权重、出院原因以及所有编码的诊断和治疗程序。进行描述性统计以及以初次髋关节置换治疗和住院死亡率为因变量的多变量逻辑回归分析。
我们从医学统计数据中获取了24678份住院病例记录。住院成本根据第二个数据集——瑞士国家成本统计数据（2012年出院的7528例髋部骨折病例）计算得出。大学医院出院病例的平均住院成本最高（21471美元，标准差17015美元），基本医保覆盖医院最低（18291美元，标准差12635美元）。在控制其他变量的情况下，大学医院髋部骨折治疗成本较高在多变量回归中具有显著性（p < 0.001）。大学医院的住院死亡率低于全面护理和基本护理机构（2.8% 对 4.0%）；我们的多变量逻辑回归分析证实了该结果（全面医保覆盖医院和基本医保覆盖医院与大学医院相比，比值比（OR）分别为1.434，95%置信区间（CI）1.127 - 1.824和OR 1.459，95%置信区间（CI）1.139 - 1.870）。私立保险参保者比例在大学医院为16.0%，在专科医院为38.9%。在预测初次髋关节置换治疗髋部骨折方面，私立保险的OR为1.419（95% CI 1.306 - 1.542）。
保险类型对髋部骨折治疗的显著影响以及不同医疗机构类型间私立保险参保分布的巨大不均衡值得监管机构进一步审视。结构护理水平较高的医院在髋部骨折治疗中具有更好的治疗效果，即更低的死亡率，这支持了医疗服务的集中化。
