Background
Current discussion
Relevant health system facts
-
Introduction of prospective payment system (DRG) (common tariff structure and hospital related base rates, inclusion of investment costs)
-
Dual-fixed financing of remuneration (min. 45% by health insurers, max. 55% by canton)
-
New criteria for hospital planning (cantonal hospital lists and service mandates including intercantonal coordination)
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Free choice of hospital for patients
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Transparency measures (e.g. publication of hospital key data and quality indicators)
Research interest from a hospital management perspective
Methods
Data sources and definition of variables
LOS Compliance | |||||||||
---|---|---|---|---|---|---|---|---|---|
Mon | Tue | Wed | Thu | Fri | Sat | Sun | All | ||
MRI | n | 271 | 298 | 274 | 206 | 189 | 84 | 24 | 1346 |
Mean S.E. | 1.90±0.101 | 1.81±0.090 | 1.89±0.110 | 2.02±0.164 | 1.68±0.129 | 2.33±0.320 | 1.97±0.315 | ||
SON | n | 78 | 77 | 90 | 83 | 104 | 26 | 28 | 486 |
Mean S.E. | 1.89±0.335 | 1.36±0.141 | 1.21±0.118 | 1.35±0.168 | 1.40±0.169 | 1.74±0.341 | 1.37±0.219 | ||
UCT | n | 498 | 523 | 471 | 499 | 451 | 279 | 290 | 3011 |
Mean S.E. | 1.68±0.104 | 1.58±0.080 | 1.75±0.085 | 1.65±0.077 | 1.67±0.096 | 1.88±0.144 | 1.84±0.116 | ||
XR | n | 1382 | 1297 | 1216 | 1060 | 845 | 401 | 327 | 6528 |
Mean S.E. | 1.46±0.047 | 1.42±0.037 | 1.40±0.041 | 1.45±0.046 | 1.36±0.049 | 1.46±0.084 | 1.60±0.119 | ||
All | 2229 | 2195 | 2051 | 1848 | 1589 | 790 | 669 | 11371 |
Working Day | Weekend Treatment | ||||
---|---|---|---|---|---|
LOSC | log(LOSC) | LOSC | log(LOSC) | ||
Working Day Scan | n | 9476 | 436 | ||
% | 83.33 | 3.84 | |||
Mean S.E | 1.55±0.017 | −0.11±0.008 | 1.31±0.069 | −0.01±0.033 | |
Weekend Scan | n | 732 | 727 | ||
% | 6.44 | 6.39 | |||
Mean S.E | 1.23±0.047 | −0.07±0.025 | 2.19±0.096 | 0.36±0.032 |
Working day treatment | Weekend treatment | ||
---|---|---|---|
Working Day Scan | Age | 63.31 | 64.29 |
Female | 0.48 | 0.47 | |
Private | 0.27 | 0.28 | |
Complex | 0.82 | 0.83 | |
Mortality | 0.06 | 0.04 | |
Number of Exams | 2.65 | 2.49 | |
Emergency | 0.85 | 0.49 | |
Diff. Treatment Scan Day | −1.61 | −0.58 | |
Diff. Scan Admission Day | 3.48 | 2.73 | |
Diff. Dismissal Scan Day | 6.51 | 7.71 | |
CT | 0.25 | 0.25 | |
MRI | 0.12 | 0.13 | |
Sonography | 0.05 | 0.04 | |
X-Ray | 0.57 | 0.59 | |
Weekend Scan | Age | 66.17 | 65.20 |
Female | 0.45 | 0.46 | |
Private | 0.27 | 0.30 | |
Complex | 0.86 | 0.90 | |
Mortality | 0.04 | 0.03 | |
Number of Exams | 2.93 | 3.13 | |
Emergency | 0.89 | 0.78 | |
Diff. Dismissal Scan Day | 8.30 | 7.62 | |
Diff. Scan Admission Day | 1.52 | 3.36 | |
Diff. Treatment Scan Day | −1.09 | 0.24 | |
CT | 0.45 | 0.33 | |
MRI | 0.10 | 0.05 | |
Sonography | 0.04 | 0.04 | |
X-Ray | 0.41 | 0.58 |
Empirical model
Results
(1) Basic model | (2) Extended model | (3) Model incl. | (4) Model incl. | (5) Emergency | (6) Non-emergency | |
---|---|---|---|---|---|---|
patient confounding | all confounders | cases | cases | |||
Constant | 0.095∗∗∗
| 0.566∗∗∗
| 0.652∗∗∗
| 0.677∗∗∗
| 0.665∗∗∗
| 0.474∗∗∗
|
(0.008) | (0.013) | (0.025) | (0.048) | (0.060) | (0.079) | |
Basic model weekends | ||||||
Admission WE | −0.053∗
| −0.062∗∗
| −0.060∗∗
| −0.038·
| −0.021 | −0.066·
|
(0.024) | (0.021) | (0.021) | (0.020) | (0.025) | (0.035) | |
Scanning WE | −0.147∗∗∗
| −0.015 | −0.016 | −0.011 | −0.039 | 0.056 |
(0.029) | (0.025) | (0.025) | (0.025) | (0.031) | (0.044) | |
Discharge WE | 0.160∗∗∗
| 0.033·
| 0.030·
| 0.013 | 0.035 | −0.006 |
(0.021) | (0.017) | (0.017) | (0.017) | (0.026) | (0.022) | |
Treatment WE | −0.104∗∗
| −0.034 | −0.036 | −0.020 | −0.022 | −0.036 |
(0.035) | (0.032) | (0.032) | (0.031) | (0.033) | (0.098) | |
Interaction WE scan and treatment | 0.536∗∗∗
| 0.258∗∗∗
| 0.263∗∗∗
| 0.211∗∗∗
| 0.227∗∗∗
| 0.113 |
(0.053) | (0.046) | (0.046) | (0.045) | (0.049) | (0.130) | |
Number of exams | −0.005 | −0.006 | 0.001 | 0.008∗
| −0.010 | |
(0.004) | (0.003) | (0.004) | (0.004) | (0.006) | ||
Diff. scan and admission (in days) | −0.047∗∗∗
| −0.047∗∗∗
| −0.048∗∗∗
| −0.055∗∗∗
| −0.038∗∗∗
| |
(0.003) | (0.003) | (0.003) | (0.003) | (0.006) | ||
Diff. treatment and scan (in days) | 0.004·
| 0.004 | 0.003 | 0.005·
| 0.005 | |
(0.003) | (0.003) | (0.003) | (0.003) | (0.005) | ||
Diff. dismissal and scan (in days) | −0.041∗∗∗
| −0.040∗∗∗
| −0.038∗∗∗
| −0.041∗∗∗
| −0.035∗∗∗
| |
(0.002) | (0.002) | (0.002) | (0.002) | (0.003) | ||
Patient data | ||||||
Female | −0.075∗∗∗
| −0.080∗∗∗
| −0.066∗∗∗
| −0.099∗∗∗
| ||
(0.012) | (0.011) | (0.016) | (0.016) | |||
Age | −0.001∗
| −0.001∗∗
| −0.002∗∗∗
| 0.000 | ||
(0.000) | (0.000) | (0.000) | (0.001) | |||
Private insurance | −0.011 | −0.006 | −0.014 | 0.000 | ||
(0.013) | (0.013) | (0.018) | (0.018) | |||
Clinical data | ||||||
Deceased | 0.463∗∗∗
| 0.477∗∗∗
| 0.369∗∗∗
| |||
(0.043) | (0.049) | (0.089) | ||||
Emergency | −0.127∗∗∗
| |||||
(0.013) | ||||||
Internal medicine case | 0.113∗∗∗
| 0.031 | 0.254∗∗∗
| |||
(0.032) | (0.038) | (0.056) | ||||
Surgical case | −0.062∗
| −0.141∗∗∗
| 0.078 | |||
(0.031) | (0.038) | (0.053) | ||||
MRI | 0.113∗∗∗
| 0.161∗∗∗
| 0.044 | |||
(0.033) | (0.041) | (0.055) | ||||
CT | 0.081∗∗
| 0.092∗
| 0.073 | |||
(0.030) | (0.037) | (0.051) | ||||
X-ray | 0.093∗∗
| 0.098∗∗
| 0.093·
| |||
(0.030) | (0.038) | (0.050) | ||||
Complicated radiology case | −0.106∗∗∗
| −0.098∗∗∗
| −0.107∗∗∗
| |||
(0.021) | (0.028) | (0.032) | ||||
Adj. R2
| 0.017 | 0.325 | 0.328 | 0.356 | 0.384 | 0.313 |
Num. obs. | 11371 | 11371 | 11371 | 11371 | 6234 | 5137 |
(1) Basic model (Omitted variable bias) | (2) Basic model | (3) Extended model | (4) Model incl. patient confounding | (5) Model incl. all confounders | |
---|---|---|---|---|---|
Constant | 0.095∗∗∗
| 0.084∗∗∗
| 0.563∗∗∗
| 0.647∗∗∗
| 0.675∗∗∗
|
(0.008) | (0.008) | (0.011) | (0.024) | (0.049) | |
Basic model weekends | |||||
Admission WE | −0.053∗
| −0.063∗
| −0.066∗∗
| −0.064∗∗
| −0.041·
|
(0.025) | (0.025) | (0.021) | (0.021) | (0.021) | |
Scanning WE | −0.147∗∗∗
| 0.011 | 0.061∗∗
| 0.061∗∗
| 0.051∗
|
(0.032) | (0.028) | (0.023) | (0.023) | (0.023) | |
Discharge WE | 0.160∗∗∗
| 0.167∗∗∗
| 0.035∗
| 0.033·
| 0.015 |
(0.020) | (0.021) | (0.017) | (0.017) | (0.017) | |
Treatment WE | −0.104∗∗
| 0.149∗∗∗
| 0.086∗∗∗
| 0.087∗∗∗
| 0.079∗∗∗
|
(0.038) | (0.028) | (0.023) | (0.023) | (0.023) | |
Interaction WE scan and treatment | 0.536∗∗∗
| ||||
(0.054) | |||||
Number of exams | -0.005 | −0.005·
| 0.001 | ||
(0.003) | (0.003) | (0.003) | |||
Diff. scan and admission (in days) | −0.048∗∗∗
| −0.048∗∗∗
| −0.049∗∗∗
| ||
(0.002) | (0.002) | (0.002) | |||
Diff. treatment and scan (in days) | 0.004∗
| 0.004∗
| 0.003·
| ||
(0.002) | (0.002) | (0.002) | |||
Diff. dismissal and scan (in days) | −0.041∗∗∗
| −0.041∗∗∗
| −0.039∗∗∗
| ||
(0.001) | (0.001) | (0.001) | |||
Patient data | |||||
Female | −0.075∗∗∗
| −0.080∗∗∗
| |||
(0.012) | (0.011) | ||||
Age | −0.001∗
| −0.001∗
| |||
(0.000) | (0.000) | ||||
Private insurance | −0.012 | −0.007 | |||
(0.013) | (0.013) | ||||
Clinical data | |||||
Deceased | 0.464∗∗∗
| ||||
(0.032) | |||||
Emergency | −0.132∗∗∗
| ||||
(0.013) | |||||
Internal medicine case | 0.113∗∗∗
| ||||
(0.034) | |||||
Surgical case | −0.065·
| ||||
(0.033) | |||||
MRI | 0.115∗∗∗
| ||||
(0.032) | |||||
CT | 0.082∗∗
| ||||
(0.030) | |||||
X-ray | 0.091∗∗
| ||||
(0.030) | |||||
Complicated radiology case | −0.104∗∗∗
| ||||
(0.020) | |||||
Adj. R2
| 0.017 | 0.009 | 0.323 | 0.326 | 0.355 |
Num. obs. | 11371 | 11371 | 11371 | 11371 | 11371 |
(1) Basic model | (2) Extended model | (3) Model incl. patient confounding | (4) Model incl. all confounders | (5) Emergency cases | (6) Non-emergency cases | |
---|---|---|---|---|---|---|
Basic model weekends | ||||||
Scanning WE | −0.181∗∗∗
| −0.079∗∗∗
| −0.080∗∗∗
| −0.071∗∗∗
| −0.061∗
| −0.079∗
|
(0.030) | (0.021) | (0.021) | (0.021) | (0.027) | (0.038) | |
Treatment WE | −0.077∗
| −0.008 | −0.009 | 0.005 | 0.011 | 0.015 |
(0.036) | (0.025) | (0.025) | (0.025) | (0.029) | (0.058) | |
Discharge WE | 0.175∗∗∗
| 0.084∗∗∗
| 0.079∗∗∗
| 0.062∗∗∗
| 0.074∗∗∗
| 0.043∗
|
(0.020) | (0.014) | (0.014) | (0.014) | (0.020) | (0.018) | |
Admission WE | −0.044·
| −0.031·
| −0.032·
| −0.016 | −0.006 | −0.005 |
(0.024) | (0.017) | (0.017) | (0.017) | (0.021) | (0.029) | |
Interaction WE scan and treatment | 0.462∗∗∗
| 0.200∗∗∗
| 0.203∗∗∗
| 0.191∗∗∗
| 0.160∗∗∗
| 0.107 |
(0.051) | (0.036) | (0.036) | (0.036) | (0.042) | (0.087) | |
Number of exams | −0.046∗∗∗
| −0.045∗∗∗
| −0.037∗∗∗
| −0.034∗∗∗
| −0.041∗∗∗
| |
(0.003) | (0.003) | (0.003) | (0.004) | (0.005) | ||
Diff. scan and admission (in days) | −0.063∗∗∗
| −0.063∗∗∗
| −0.062∗∗∗
| −0.068∗∗∗
| −0.055∗∗∗
| |
(0.002) | (0.002) | (0.002) | (0.003) | (0.003) | ||
Diff. treatment and scan (in days) | 0.007∗∗∗
| 0.007∗∗∗
| 0.008∗∗∗
| 0.014∗∗∗
| 0.001 | |
(0.001) | (0.001) | (0.001) | (0.002) | (0.002) | ||
Diff. dismissal and scan (in days) | −0.051∗∗∗
| −0.051∗∗∗
| −0.050∗∗∗
| −0.056∗∗∗
| −0.041∗∗∗
| |
(0.001) | (0.001) | (0.001) | (0.001) | (0.001) | ||
Patient data | ||||||
Female | −0.038∗∗∗
| −0.041∗∗∗
| −0.044∗∗
| −0.039∗∗
| ||
(0.010) | (0.010) | (0.014) | (0.013) | |||
Age | −0.003∗∗∗
| −0.003∗∗∗
| −0.003∗∗∗
| −0.003∗∗∗
| ||
(0.000) | (0.000) | (0.000) | (0.000) | |||
Private insurance | 0.009 | 0.006 | 0.008 | 0.023 | ||
(0.011) | (0.010) | (0.015) | (0.014) | |||
Clinical data | ||||||
Deceased | 0.355∗∗∗
| 0.351∗∗∗
| 0.150∗∗
| |||
(0.029) | (0.035) | (0.057) | ||||
Emergency | −0.120∗∗∗
| |||||
(0.012) | ||||||
Internal medicine case | ||||||
Surgical case | ||||||
MRI | −0.007 | −0.010 | 0.009 | |||
(0.028) | (0.037) | (0.045) | ||||
CT | 0.011 | 0.004 | 0.001 | |||
(0.025) | (0.033) | (0.041) | ||||
X-ray | 0.069∗∗
| 0.052 | 0.099∗
| |||
(0.025) | (0.033) | (0.042) | ||||
Complicated radiology case | −0.143∗∗∗
| −0.148∗∗∗
| −0.123∗∗∗
| |||
(0.017) | (0.023) | (0.025) | ||||
R2 (proj model) | 0.019 | 0.501 | 0.506 | 0.520 | 0.539 | 0.468 |
Num. obs. | 11371 | 11371 | 11371 | 11371 | 6234 | 5137 |
R2 (full model) | 0.244 | 0.616 | 0.619 | 0.630 | 0.667 | 0.666 |
Discussion
Patient days (PD) | ALOS | Beds | |
---|---|---|---|
Total patients CH | 1′123′995 | 6.2 | |
OFSP3 2012 | 6’944’354 | 23’852 | |
Required beds by calculation(ALOS*Nbr. of Patients/365) | 19’026 | ||
General bed utilization | 79.8%
| ||
Required emergency beds only (54.8% of the study cases) | 10′426 | ||
Efficiency gains (only on emergency beds and based on total weekend effect) | −1.37 | 2’312 | |
Required beds incl. Efficiency | 4.83 | 16’714 | |
Bed utilization (incl. efficiency gains only on emergency beds) | 70.1%
|