Bes Romy E, Curfs Emile C, Groenewegen Peter P, de Jong Judith D
NIVEL (Netherlands institute for health services research), Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands.
Open University, Valkenburgerweg 177, 6419, AT, Heerlen, The Netherlands.
BMC Health Serv Res. 2018 Nov 6;18(1):832. doi: 10.1186/s12913-018-3624-6.
In a health care system based on managed competition it is important that health insurers are able to channel their enrolees to preferred care providers. However, enrolees are often very negative about financial incentives and any limitations in their choice of care provider. Therefore, a Dutch health insurance company conducted an experiment to study the effectiveness of a new method of channelling their enrolees. This method entails giving enrolees advise on which physiotherapists to choose when they call customer service. Offering this advice as an extra service is supposed to improve service quality ratings. Objective of this study is to evaluate this channelling method on effectiveness and the impact on service quality ratings.
In this experiment, one of the health insurer's customer service call teams (pilot team) began advising enrolees on their choice of physiotherapist. Three data sources were used. Firstly, all enrolees who called customer service received an online questionnaire in order to measure their evaluation of the quality of service. Enrolees who were offered advice received a slightly different questionnaire which, in addition, asked about whether they intended to follow the advice they were offered. Multilevel regression analysis was conducted to analyse the difference in service quality ratings between the pilot team and two comparable customer service teams before and after the implementation of the channelling method. Secondly, employees logged each call, registering, if they offered advice, whether the enrolee accepted it, and if so, which care provider was advised. Thirdly, data from the insurance claims were used to see if enrolees visited the recommended physiotherapist.
The results of the questionnaire show that enrolees responded favorably to being offered advice on the choice of physiotherapist. Furthermore, 45% of enrolees who received advice and then went on to visit a care provider, followed the advice. The service quality ratings were higher compared to control groups. However, it could not be determined whether this effect was entirely due to the intervention.
Channelling enrolees towards preferred care providers by offering advice on their choice of care provider when they call customer service is successful. The effect on service quality seems positive, although a causal relationship could not be determined.
在基于管理式竞争的医疗保健系统中，健康保险公司能够将其参保人引导至首选的医疗服务提供者至关重要。然而，参保人通常对经济激励措施以及他们选择医疗服务提供者时的任何限制持非常消极的态度。因此，一家荷兰健康保险公司进行了一项实验，以研究一种引导其参保人的新方法的有效性。这种方法要求在参保人致电客户服务时，就选择哪些物理治疗师向他们提供建议。将提供此建议作为一项额外服务，旨在提高服务质量评级。本研究的目的是评估这种引导方法的有效性以及对服务质量评级的影响。
在该实验中，健康保险公司的一个客户服务呼叫团队（试点团队）开始就参保人对物理治疗师的选择提供建议。使用了三个数据源。首先，所有致电客户服务的参保人都收到一份在线问卷，以衡量他们对服务质量的评价。接受建议的参保人收到一份略有不同的问卷，此外，该问卷还询问他们是否打算遵循所提供的建议。在实施引导方法之前和之后，进行了多层次回归分析，以分析试点团队与两个可比客户服务团队之间服务质量评级的差异。其次，员工记录每次通话，记录他们是否提供建议、参保人是否接受建议以及如果接受，建议的是哪家医疗服务提供者。第三，使用保险理赔数据查看参保人是否拜访了推荐的物理治疗师。
问卷结果表明，参保人对就物理治疗师的选择提供建议反应良好。此外，在接受建议并随后拜访医疗服务提供者的参保人中，45%遵循了建议。与对照组相比，服务质量评级更高。然而，无法确定这种效果是否完全归因于干预措施。
当参保人致电客户服务时，通过就他们对医疗服务提供者的选择提供建议，将参保人引导至首选的医疗服务提供者是成功的。对服务质量的影响似乎是积极的，尽管无法确定因果关系。
