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  1. Health care expenditures after introduction of a gatekeeper and a global budget in a Swiss health insurance plan.

    Article - En anglais

    Study objectives-To assess whether the introduction of « managed care » (capitated budget and utilisation control by general practitioners) in a Swiss health insurance plan caused a selective disenrolment of plan members, and whether it achieved its goal of reducing health care expenditures.

    Design-Controlled before-after analysis of health insurance claims.

    Setting-Health insurance plan of the University of Geneva, Switzerland, which introduced managed care at the end of 1992, and comparison plan, which reimbursed health care expenditures without setting a budget or controlling access.

    Participants-Analysis of self selection :

    University plan members who accepted (3993) or refused (659) transfer to managed care.

    Analysis of change in expenditures : cohorts of persons continuously enrolled in the university (1575) and comparison (3384) plans in 1992 and 1993.

    Main results-During 1992, the year before the transformation of the university plan, persons who refused managed care had generated 35% higher expenditures than those who accepted managed care (p<0.001).

    Between 1992 and 1993, expenditures per member decreased by 9% in the university cohort and increased by 11% in the comparison cohort (p=0.004).

    Technical procedures (laboratory tests, physical therapy, drugs) decreased most in the university plan.

    No impact on hospital admissions was detected. (...)

    Mots-clés Pascal : Soin intégré, Coût, Assurance maladie, Médecin généraliste, Service santé, Evaluation, Homme, Economie santé, Système santé, Politique sanitaire, Suisse, Europe, Personnel sanitaire, Planification

    Mots-clés Pascal anglais : Managed care, Costs, Health insurance, General practitioner, Health service, Evaluation, Human, Health economy, Health system, Health policy, Switzerland, Europe, Health staff, Planning

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0289096

    Code Inist : 002B30A01B. Création : 27/11/1998.