Department of Public Health and Health Technology Assessment, UMIT, University of Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer Zentrum 1, A-6060 Hall in Tyrol, Austria.
Int J Integr Care. 2012 Jan-Mar;12:e2. doi: 10.5334/ijic.685. Epub 2012 Jan 13.
This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.
The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006-2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.
Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5%, respectively, of the variation in total health care expenditure can be attributed to the effects of selection.
Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy-makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.
本研究调查了瑞士综合护理模式的效率提高，因为这些模式被认为是国家社会医疗保险中控制成本的选择。这些计划产生的平均医疗保健支出远低于基本保险计划。然而，问题是这些总储蓄在多大程度上归因于选择和效率的影响。
实证分析基于 399274 名瑞士居民的数据，这些居民持续拥有瑞士最大的健康保险公司 Helsana Group 的强制性健康保险，涵盖 2006-2009 年。为了评估不同综合护理模式的效率，我们采用了一种带有混合效应模型的计量经济学方法。
我们的估计表明，综合护理模式对医疗支出的效率影响是显著的。然而，不同的保险计划存在差异，显示出以下每种模式的效率收益：合同总额付费模式为 21.2%，合同非总额付费模式为 15.5%，远程医疗模式为 3.7%。剩余的 8.5%、5.6%和 22.5%分别归因于选择效应。
综合护理模式有可能改善慢性病患者的护理，同时对医疗支出产生积极影响。我们建议政策制定者在现有法规中为慢性病患者改善激励措施，为医疗保健的成本效益提供进一步的潜力。
