Objectives In spring 2020, Switzerland banned the provision of non-urgent healthcare services in order to free capacities for patients with COVID-19 and to reduce the spread of the virus. During this period, prioritization of care should have been based on medical urgency. It is possible, however, that hospitals gave preference to patients with private insurance because of their higher tariffs. With this study, we aimed to investigate determinants of procedure prioritization, including procedure type, diagnoses, and insurance status, for different inpatient procedures (cardiovascular, orthopedic, cancer-related).
Method This was a retrospective cohort study based on routine inpatient data from all Swiss hospitals from January 2017 up to mid-April of 2020 (end of the shutdown period in Switzerland). Procedures of patients admitted for cardiovascular, musculoskeletal or cancer disorders were considered. We used negative binomial generalized linear mixed-effects models to analyze weekly procedure counts.
Results Preliminary results showed that procedure counts decreased during the ban in all three groups, most prominently in orthopedic procedures (approx. -80% vs. -40% for cardiovascular and for cancer-related procedures, p<0.05). The decrease depended on the individual procedure (with diagnostic procedures such as coronary arteriography decreasing disproportionally) but also on the patients’ diagnosis. For instance, percutaneous transluminal coronary angioplasty procedures decreased more in patients with chronic ischaemic heart disease than in those admitted for acute myocardial infarction. Private insurance status was associated with a smaller decrease during the ban for orthopedic procedures.
Conclusions Our preliminary results suggest that prioritization during the COVID-19-induced ban on procedures was largely governed by urgency. However, for certain procedures, privately insured patients appear to have received preferential treatment, raising concerns of inappropriate prioritization based on economic considerations.
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