title: The provision of out-of-hours care and associated costs in an urban area of Switzerland: a cost description study.
abstract: BACKGROUND
  In Switzerland, General Practitioners (GPs) play an important role for out-of-hours emergency care as one service option beside freely accessible and costly emergency departments of hospitals. The aim of this study was to evaluate the services provided and the economic consequences of a Swiss GP out-of-hours service.
  
  
  METHODS
  GPs participating in the out-of-hours service in the city of Zurich collected data on medical problems (ICPC coding), mode of contact, mode of resource use and services provided (time units; diagnostics; treatments). From a health care insurance perspective, we assessed the association between total costs and its two components (basic costs: charges for time units and emergency surcharge; individual costs: charges for clinical examination, diagnostics and treatment in the discretion of the GP).
  
  
  RESULTS
  125 GPs collected data on 685 patient contacts. The most prevalent health problems were of respiratory (24%), musculoskeletal (13%) and digestive origin (12%). Home visits (61%) were the most common contact mode, followed by practice (25%) and telephone contacts (14%). 82% of patients could be treated by ambulatory care. In 20% of patients additional technical diagnostics, most often laboratory tests, were used. The mean total costs for one emergency patient contact were €144 (95%-CI: 137-151). The mode of contact was an important determinant of total costs (mean total costs for home visits: €176 [95%-CI: 168-184]; practice contact: €90 [95%-CI: 84-98]; telephone contact: €48 [95%-CI: 40-55]). Basic costs contributed 83% of total costs for home visits and 70% of total costs for practice contacts. Individual mean costs were similarly low for home visits (€30) and practice contacts (€27). Medical problems had no relevant influence on this cost pattern.
  
  
  CONCLUSIONS
  GPs managed most emergency demand in their out-of-hours service by ambulatory care. They applied little diagnostic testing and basic care. Our findings are of relevance for policy makers even from other countries with different pricing policies. Policy makers should be interested in a reimbursement system promoting out-of-hours care run by GPs as one valuable service option.
authors.affiliation: Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland. Klaus.Eichler@zhaw.ch
authors.forename: Klaus
authors.initials: K
authors.lastname: Eichler
authors.forename: Daniel
authors.initials: D
authors.lastname: Imhof
authors.forename: Corrine
authors.initials: C
authors.lastname: Chmiel
authors.forename: Marco
authors.initials: M
authors.lastname: Zoller
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.forename: Carola A
authors.initials: CA
authors.lastname: Huber
mesh_terms: D039602:After-Hours Care / Q000191:economics*; D000553:Ambulatory Care / Q000191:economics*; D003365:Costs and Cost Analysis; D004638:Emergency Treatment / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006792:House Calls / Q000191:economics*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D011320:Primary Health Care / Q000191:economics*; D013557:Switzerland; D013689:Telephone; D019037:Urban Health Services / Q000191:economics