IEMS, University of Lausanne, Lausanne-Dorigny, Switzerland.
Health Econ. 2011 Oct;20(10):1257-67. doi: 10.1002/hec.1668. Epub 2010 Oct 3.
This paper aims to estimate empirically the efficiency of a Swiss telemedicine service introduced in 2003. We used claims' data gathered by a major Swiss health insurer, over a period of 6 years and involving 160 000 insured adults. In Switzerland, health insurance is mandatory, but everyone has the option of choosing between a managed care plan and a fee-for-service plan. This paper focuses on a conventional fee-for-service plan including a mandatory access to a telemedicine service; the insured are obliged to phone this medical call centre before visiting a physician. This type of plan generates much lower average health expenditures than a conventional insurance plan. Reasons for this may include selection, incentive effects or efficiency. In our sample, about 90% of the difference in health expenditure can be explained by selection and incentive effects. The remaining 10% of savings due to the efficiency of the telemedicine service amount to about SFr 150 per year per insured, of which approximately 60% is saved by the insurer and 40% by the insured. Although the efficiency effect is greater than the cost of the plan, the big winners are the insured who not only save monetary and non-monetary costs but also benefit from reduced premiums.
本文旨在对瑞士于 2003 年引入的远程医疗服务的效率进行实证评估。我们使用了一家主要的瑞士健康保险公司在六年期间收集的索赔数据，涉及 16 万成年被保险人。在瑞士，健康保险是强制性的，但每个人都可以选择管理式医疗计划或按服务收费计划。本文重点介绍了一种传统的按服务收费计划，其中包括强制性获得远程医疗服务的机会；被保险人在看医生之前必须拨打这个医疗呼叫中心的电话。这种类型的计划比传统的保险计划产生的平均医疗支出要低得多。原因可能包括选择、激励效应或效率。在我们的样本中，健康支出差异的约 90%可以用选择和激励效应来解释。远程医疗服务效率节省的剩余 10%，相当于每个被保险人每年约 150 瑞士法郎，其中约 60%由保险公司节省，40%由被保险人节省。尽管效率效应大于计划成本，但最大的赢家是被保险人，他们不仅节省了货币和非货币成本，还从降低的保费中受益。
