Health care spending by disease in Switzerland in 2012 and 2017 : a decomposition analysis

Objectives: The drivers of the increasing health care spending in Switzerland are poorly understood. We decompose spending by diseases and other dimensions and estimate the contribution of single cost drivers to spending growth between 2012 and 2017. Methods: We decompose total healthcare spending by 45 major diseases, 19 health services, 21 age groups, and gender of patients and identify the contribution of four main drivers of spending: population growth, population structure, disease prevalence, and spending per prevalent patient. The analysis is based on micro-data from a multitude of data sources (hospital inpatient registry, health and accident insurance claims data, etc.). Results: Total health care spending increased by 19.7 % from 2012 to 2017. Preliminary results show that musculoskeletal diseases were the most expensive disease group in both years. The largest increase in relative spending was observed for nutritional deficiencies, sense organ diseases, well care, and neoplasms. Cardiovascular diseases and mental disorders showed belowaverage growth rates. Spending per prevalent patient was the most important driver of the spending growth. Conclusions: A large part of health care spending growth in Switzerland was associated with increases in spending per patient. This must be due to higher treatment intensity or to the introduction of new expensive treatments, as prices of existing treatments did not in increase the study period