In Switzerland, compulsory basic health insurance guarantees access to standard medical care, whereas supplementary insurance primarily offers benefits such as enhanced comfort and free choice of the attending physician. Whether supplementary insurance translates into superior surgical outcomes remains uncertain.
Using a propensity score-matched analysis, 3,173 abdominal, thoracic, and vascular surgeries performed at a Swiss tertiary centre between 2016 and 2018 were examined to assess whether supplementary health insurance was associated with lower postoperative complication rates.
After adjustment for confounding, complication rates were comparable between patients with basic and supplementary insurance (OR 0.97, 95% CI 0.77-1.23). Complications were instead associated with surgical complexity, wound contamination, operative duration, emergency status, higher ASA score, and older age.
In conclusion, supplementary health insurance was not associated with reduced postoperative complications, supporting comparable surgical quality within the Swiss healthcare system.
Interview with Simon Wrann, Stefan Gutknecht and Maximilian Bley
What inspired you to conduct this study?
Questions about the influence of insurance status on the quality of care are common among both patients and physicians. In this study, we aimed to assess whether perioperative complication rates differ according to health insurance class within the Swiss healthcare system. Providing evidence of equity in perioperative complications, independent of the insurance class, was of substantial importance for us.
Were there any unexpected findings?
When comparing insurance status, we faced a challenging scenario with substantial confounding. Notably, patients with supplementary insurance were frequently older and they had more complex surgical procedures. Failure to take these factors into account could lead to misleading conclusions regarding perioperative complications depending on insurance status. These insights support the importance of adjusting for confounders and highlights the need for further prospective studies classifying this complex area.
What is the direct impact on the surgeon's work?
We found no difference in perioperative complications depending on insurance status in this study. Perhaps the main implication for surgeons in Switzerland is the knowledge that they do not need to change their behavior with regard to perioperative complications based on insurance status.
What is your learning point from this project?
Our findings suggest that even basic insurance in Switzerland provides a high standard of perioperative surgical care. In our opinion, this achievement demonstrates again the high performance of all surgical health care providers in Switzerland. Whether this high level of performance receives sufficient recognition is a question that should be answered personally.
Are there any subsequent projects planned?
This study could serve as a foundation for generating prospective data on surgical performance, particularly in dependence on external factors such as insurance status. While not yet planned, prospective multicentric studies could play a crucial role for further clarification.
