Health care expenditures after introduction of a gatekeeper and a global budget in a Swiss health insurance plan.
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
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0289096
Code Inist : 002B30A01B. Création : 27/11/1998.