What drives health care spending in Switzerland? Findings from a decomposition by disease, health service, sex, and age

Background

High and increasing spending dominates the public discussion on healthcare in Switzerland. However, 
the drivers of the spending increase are poorly understood. This study decomposes health care spending by diseases 
and other perspectives and estimates the contribution of single cost drivers to overall healthcare spending growth 
in Switzerland between 2012 and 2017.

Methods

We decompose total healthcare spending according to National Health Accounts by 48 major diseases, 
injuries, and other conditions, 20 health services, 21 age groups, and sex of patients. This decomposition is based 
on micro-data from a multitude of data sources such as the hospital inpatient registry, health and accident insur‑
ance claims data, and population surveys. We identify the contribution of four main drivers of spending: population 
growth, change in population structure (age/sex distribution), changes in disease prevalence, and changes in spend‑
ing per prevalent patient.

Results

Mental disorders were the most expensive major disease group in both 2012 and 2017, followed by musculoskeletal disorders and neurological disorders. Total health care spending increased by 19.7% between 2012 and 2017. 
An increase in spending per prevalent patient was the most important spending driver (43.5% of total increase), fol‑
lowed by changes in population size (29.8%), in population structure (14.5%), and in disease prevalence (12.2%).

Conclusions

A large part of the recent health care spending growth in Switzerland was associated with increases 
in spending per patient. This may indicate an increase in the treatment intensity. Future research should show 
if the spending increases were cost-efective