Abstract
BACKGROUND: Chronic diseases are an increasing burden for Swiss healthcare. Demographic change aggravates the problem, with an ageing, multi-morbid population increasing the need for care while also depleting the healthcare workforce. Originally developed to assess the structural quality of and access to primary care, Potentially Avoidable Hospitalizations (PAHs) are an OECD-metric employed as an indicator of inpatient burden for various chronic diseases. So far, evidence on future PAH-burden remains limited. AIMS: (1) To assess the evolution of PAHs and associated resources (bed capacities, inpatient healthcare expenditures) in Switzerland for chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), hypertension and diabetes between 2012 and 2022, (2) to forecast PAHs until 2032, based on expected demographic change and (3) to explore methodologically how changes in primary care physician (PCP)-supply and countermeasures might influence future PAH-development. METHODS: We identified PAHs in retrospective routine hospital data and derived numbers of occupied hospital beds, based on cases' length of stay, and inpatient healthcare expenditures, based on diagnosis-related group payments. We utilized population forecasts for Switzerland to extrapolate PAH-volume in the base scenario. Additionally, we predicted via linear regression how reduced ageing-induced PCP-availability might affect PAHs. Finally, we explored the potential impact of countermeasures, optimal Guideline-Directed Medical Therapy (GDMT)-implementation, for CHF and COPD. RESULTS: The number of PAHs across all five chronic diseases increased from 30.1 to 40.2 thousand cases between 2012 and 2019 (+ 34%) and is projected to rise to 54.9 thousand cases until 2032 (+ 37%). We project PAH-volume to increase by an additional 11% by 2032 due to changes in PCP-supply. By 2032, optimal GDMT-implementation has the potential to reduce CHF- and COPD-related PAH-volumes by 31% (95% CI: 22.23-37.60%) and 14% (95% CI: 2.17-26.02%), respectively. CONCLUSIONS: Our study assesses cumulative PAH-trends and is the first to forecast future burden in Switzerland. A strong rise in PAHs and associated inpatient resources was registered for the last decade, with accelerating growth expected throughout the next. A depleting healthcare workforce may exacerbate burden. Optimal GDMT-implementation could potentially curb increases in PAHs. However, methods to reach optimal implementation require further research and policy efforts.