Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland.
Department of Health Sciences, Helsana Insurance Group, Zurich, Switzerland.
Eur J Health Econ. 2018 Nov;19(8):1149-1161. doi: 10.1007/s10198-018-0963-5. Epub 2018 Feb 22.
In most countries, surprisingly little is known on how national healthcare spending is distributed across diseases. Single-disease cost-of-illness studies cover only a few of the diseases affecting a population and in some cases lead to untenably large estimates. The objective of this study was to decompose healthcare spending in 2011, according to Swiss National Health Accounts, into 21 collectively exhaustive and mutually exclusive major disease categories. Diseases were classified following the Global Burden of Disease Study. We first assigned the expenditures directly mapping from National Health Accounts to the 21 diseases. The remaining expenditures were assigned based on diagnostic codes and clues contained in a variety of microdata sources. Expenditures were dominated by non-communicable diseases with a share of 79.4%. Cardiovascular diseases stood out with 15.6% of total spending, followed by musculoskeletal disorders (13.4%), and mental and substance use disorders (10.6%). Neoplasms (6.0% of the total) ranked only sixth, although they are the leading cause of premature death in Switzerland. These results may be useful for the design of health policies, as they illustrate how healthcare spending is influenced by the epidemiological transition and increasing life expectancy. They also provide a plausibility check for single cost-of-illness studies. Our study may serve as a starting point for further research on the drivers of the constant growth of healthcare spending.
在大多数国家，人们对国家医疗支出在疾病间的分配情况知之甚少。单病种疾病负担研究仅涵盖了部分影响人群的疾病，而且在某些情况下导致了难以承受的过高估计。本研究旨在根据瑞士国家卫生账户，将 2011 年的医疗支出分解为 21 个具有共同穷尽和相互排斥性质的主要疾病类别。疾病的分类遵循全球疾病负担研究。我们首先将直接映射到 21 种疾病的国家卫生账户支出进行分类。其余支出则根据诊断代码和各种微观数据来源中包含的线索进行分类。支出主要由非传染性疾病主导，占 79.4%。心血管疾病以 15.6%的总支出位居首位，其次是肌肉骨骼疾病（13.4%）和精神与物质使用障碍（10.6%）。肿瘤（占总支出的 6.0%）仅排名第六，尽管它们是瑞士过早死亡的主要原因。这些结果可能对卫生政策的制定有用，因为它们说明了医疗支出如何受到流行病学转变和预期寿命延长的影响。它们还为单一疾病负担研究提供了可信度检查。我们的研究可以作为进一步研究医疗支出持续增长驱动因素的起点。
