Dataset Information

The quality of primary care in a country with universal health care coverage.

ABSTRACT:

Background

Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.

Objective

To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage.

Design and participants

Retrospective cohort of a random sample of 1,002 patients aged 50-80 years followed for 2 years from all Swiss university primary care settings.

Main measures

We used indicators derived from RAND's Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator.

Key results

Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p < 0.001 for comparisons with blood pressure and weight measurements). Eighty-three percent of patients received the recommended care for cardiovascular risk factors, including >75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p < 0.001) and patients <65 years (70.1% vs 68.0% in those ? 65 years, p = 0.047).

Conclusions

Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europe.

SUBMITTER: Collet TH

PROVIDER: S-EPMC3138580 | biostudies-literature | 2011 Jul

REPOSITORIES: biostudies-literature

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Publications

The quality of primary care in a country with universal health care coverage.

Collet Tinh-Hai TH Salamin Sophie S Zimmerli Lukas L Kerr Eve A EA Clair Carole C Picard-Kossovsky Michel M Vittinghoff Eric E Battegay Edouard E Gaspoz Jean-Michel JM Cornuz Jacques J Rodondi Nicolas N

Journal of general internal medicine 20110322 7

<h4>Background</h4>Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.<h4>Objective</h4>To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage.<h4>Design and participants</h4>Retrospective cohort of a random sample of 1,002 patients aged 50-80 years followed for 2 years from all Swiss university ...[more]

PMID: 21424868

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Project description:ImportanceCharacteristics of a health care system can facilitate forgoing of health care owing to economic reasons and can influence population health. Whether health insurance deductibles are associated with forgoing of health care in a consumer-driven health care system with universal coverage, such as the Swiss health system, remains to be determined.ObjectiveTo assess the association between insurance plan deductibles and forgoing of health care with consideration of socioeconomic factors.Design, setting, and participantsThis cross-sectional study was conducted in Geneva, Switzerland, using data collected from January 1, 2007, to December 31, 2019. Population-based samples were obtained yearly through random stratified sampling by age and sex of the general population aged 20 to 74 years. Participants were invited to an appointment at 1 of the 3 study sites in Geneva, where they completed a sociodemographic and health questionnaire.ExposuresInsurance plan deductible level.Main outcomes and measuresThe main outcome was forgoing of health care owing to economic reasons. Unadjusted and multivariable Poisson models were used to assess the association between deductible level and forgoing of health care. Differences in forgoing health care across the range of health insurance deductibles or household income levels were quantified using the relative index of inequality (RII).ResultsThe study group included 11 872 participants (5974 [50.3%] male; median age, 48.1 years [interquartile range, 38.7-59.1 years]); 1146 (9.7%) reported forgoing health care. Participants with high-deductible plans reported forgoing health care more frequently than those with low-deductible plans (331 [13.5%] vs 591 [8.7%]). In adjusted analysis, higher-deductible plans were associated with a greater likelihood of forgoing health care (RII, 2.2; 95% CI, 1.7-3.0; P < .001) independently of socioeconomic status, known comorbidities, and cardiovascular risk factors. Deductible level was associated with forgoing of health care among participants younger than 40 years (RII, 2.5; 95% CI, 1.6-4.0; P < .001) and those aged 40 to 64 years (RII, 1.9; 95% CI, 1.3-2.9; P = .002) but not among those older than 65 years (RII, 2.9; 95% CI, 0.8-10.4; P = .11).Conclusions and relevanceIn this cross-sectional study, high insurance plan deductibles were associated with forgoing of health care independent of socioeconomic status and preexisting conditions in a universal consumer-driven health care system with good population outcomes in Switzerland. Uncovering health care system design features that could lead to suboptimal population care may help decision makers improve their current health care system design to achieve better outcomes.

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Dataset Information

The quality of primary care in a country with universal health care coverage.

Background

Objective

Design and participants

Main measures

Key results

Conclusions

Publications

The quality of primary care in a country with universal health care coverage.

Similar Datasets

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