Allard P, Deligne J, Van Bockstael V, Duquesnoy B
National Health Insurance Payment Center for Northern France, Lille, France.
Rev Rhum Engl Ed. 1998 Mar;65(3):173-80.
To evaluate the cost-effectiveness of spa therapy for rheumatic diseases and sequelae of bone and joint injuries.
A prospective randomized, case-control design was used with health care cost reimbursements during the year before and after spa therapy as the measure of efficacy. Spa therapy is reimbursed by the national health insurance system in France, subject to prior agreement. The 220 patients who filed applications for spa therapy with the national health insurance payment center for northern France during the first half of 1994 were included in the study. Seventy-two patients met national health insurance system criteria for spa therapy (Group 1), the remaining 148 patients were assigned at random to spa therapy (Group 2, n = 74) or no spa therapy (Group 3, n = 74). This method allowed us to avoid selection bias during recruitment of our control group.
Perceived morbidity was evaluated based on health care utilization, expressed as numbers of health care investigations or procedures and as days of medication use in mean recommended dosages. Health care cost reimbursements by the national health insurance system failed to decrease during the year after spa therapy, and increased in those patients who had already received spa therapy on one or more occasions. Only in the first-ever spa patients were decreases in health care utilization in the area of rheumatology seen during the year after spa therapy; the largest decreases were for use of nonsteroidal antiinflammatory drugs (from 49 to 26 days) and muscle relaxants. No differences in health care utilization were found in patients who had received spa therapy on at least one other occasion. Also, when criteria for spa therapy were not met, no differences in health care utilization were found between patients who did and did not receive spa therapy.
These data suggest that current national health insurance policies regarding the reimbursement of spa therapy need to be reevaluated.
评估温泉疗法对风湿性疾病及骨关节损伤后遗症的成本效益。
采用前瞻性随机病例对照设计，以温泉疗法前后一年的医疗费用报销情况作为疗效指标。在法国，温泉疗法需事先获批，方可由国家医疗保险系统报销。1994年上半年向法国北部国家医疗保险支付中心申请温泉疗法的220例患者纳入本研究。72例患者符合国家医疗保险系统的温泉疗法标准（第1组），其余148例患者随机分为接受温泉疗法组（第2组，n = 74）和不接受温泉疗法组（第3组，n = 74）。此方法使我们能够避免在对照组招募过程中出现选择偏倚。
根据医疗保健利用情况评估感知发病率，以医疗检查或程序的数量以及按平均推荐剂量计算的用药天数表示。国家医疗保险系统的医疗费用报销在温泉疗法后的一年中并未减少，且在那些曾接受过一次或多次温泉疗法的患者中有所增加。仅在首次接受温泉疗法的患者中，温泉疗法后的一年里在风湿病领域的医疗保健利用有所减少；减少最多的是使用非甾体抗炎药（从49天降至26天）和肌肉松弛剂。在至少接受过一次其他温泉疗法的患者中，医疗保健利用情况未发现差异。此外，当不符合温泉疗法标准时，接受和未接受温泉疗法的患者在医疗保健利用方面未发现差异。
这些数据表明，当前国家医疗保险关于温泉疗法报销的政策需要重新评估。
