Sommer J H, Bürgi M, Theiss R
University of Basel, Health Economics and Social Policy Research Unit, Switzerland.
Complement Ther Med. 1999 Jun;7(2):54-61. doi: 10.1016/s0965-2299(99)80083-1.
The present investigation focuses on the following questions: 1. Are complementary medical services paid for by a health insurer used in addition to orthodox medical services, or as substitute for them?; 2. If health insurers include complementary medical services in the basic cover, what will be the effect on costs?; 3. If complementary medical services as included in the basic cover, what will be the effect on the policyholders' subjective state of health?
A randomized experiment was set up in which 7500 members of Switzerland's biggest health insurance fund, Helvetia, were offered free supplementary insurance for alternative medicine for 3 years. This simulated a situation in which the experimental group had access to the full range of complementary medical treatments under their health insurance policies. The remaining members in the scheme (670,000) people) formed the control group. To evaluate the effect on costs, we analysed the health insurer's cost and benefits data. In addition, a survey was carried out among random samples of subjects from the experimental group and from the control group using the 36-Item Short-Form Health Survey (SF-36) to examine the effects of including complementary medicine on subjective state of health.
The analysis of the cost data shown that subjects used alternative in addition to orthodox medical services. It is also clear that alternative medical treatments are given in combination with orthodox medicine; less than 1% of the experimental group used exclusively alternative medical services. However, as only a very small percentage of experimental subjects (6.6%) took advantage of complementary medicine, no significant impact on overall health costs can be inferred. On the other hand, multiple regressions show that use of complementary medicine has a greater effect on treatment costs than sex, age or language region. Neither at the beginning nor the end of the experiment were any significant differences noted in the scales of the SF-36 between the experimental and the control group. Nor did multiple regressions reveal any effects on subjects' state of health due to the inclusion of complementary medicine in the basic insurance cover.
本调查聚焦于以下问题：1. 健康保险公司支付的补充医疗服务是在正统医疗服务之外使用，还是作为其替代品？2. 如果健康保险公司将补充医疗服务纳入基本保险范围，对成本会有什么影响？3. 如果补充医疗服务被纳入基本保险范围，对投保人的主观健康状况会有什么影响？
开展了一项随机实验，为瑞士最大的健康保险基金Helvetia的7500名成员提供了为期3年的免费替代医学补充保险。这模拟了一种情况，即实验组可以根据其健康保险政策获得全方位的补充医疗治疗。该计划中的其余成员（67万人）组成了对照组。为了评估对成本的影响，我们分析了健康保险公司的成本和收益数据。此外，使用36项简短健康调查（SF - 36）对实验组和对照组的随机样本进行了调查，以研究纳入补充医学对主观健康状况的影响。
成本数据分析表明，受试者除了使用正统医疗服务外还使用了替代医学。同样明显的是，替代医学治疗是与正统医学结合使用的；实验组中只有不到1%的人仅使用替代医学服务。然而，由于只有极少数实验对象（6.6%）利用了补充医学，因此无法推断出对总体医疗成本有显著影响。另一方面，多元回归表明，使用补充医学对治疗成本的影响大于性别、年龄或语言区域。在实验开始和结束时，实验组和对照组在SF - 36量表上均未发现任何显著差异。多元回归也未揭示基本保险范围中纳入补充医学对受试者健康状况有任何影响。
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