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Published in: BMC Health Services Research 1/2006

Open Access 01-12-2006 | Research article

Extent and structure of health insurance expenditures for complementary and alternative medicine in Swiss primary care

Authors: Andre Busato, Reiner Eichenberger, Beat Künzi

Published in: BMC Health Services Research | Issue 1/2006

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Abstract

Background

The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. The goal was to evaluate the extent and structure of basic health insurance expenditures for complementary and alternative medicine in Swiss primary care.

Methods

The study was designed as a cross-sectional evaluation of Swiss primary care providers and included 262 certified CAM physicians, 151 noncertified CAM physicians and 172 conventional physicians. The study was based on data from a mailed questionnaire and on reimbursement information obtained from health insurers. It was therefore purely observational, without interference into diagnostic and therapeutic procedures applied or prescribed by physicians. Main outcome measures included average reimbursed costs per patient, structured into consultation- and medication-related costs, and referred costs.

Results

Total average reimbursed cost per patient did not differ between CAM physicians and conventional practitioners, but considerable differences were observed in cost structure. The proportions of reimbursed costs for consultation time were 56% for certified CAM, 41% for noncertified CAM physicians and 40% for conventional physicians; medication costs – including expenditures for prescriptions and directly dispensed drugs – respectively accounted for 35%, 18%, and 51% of costs.

Conclusion

The results indicate no significant difference for overall treatment cost per patient between CAM and COM primary care in Switzerland. However, CAM physicians treat lower numbers of patients and a more cost-favourable patient population than conventional physicians. Differences in cost structure reflect more patient-centred and individualized treatment modalities of CAM physicians.
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Literature
1.
go back to reference Melchart D, Mitscherlich. F, Amiet M, Eichenberger R, Koch P: Programm Evaluation Komplementärmedizin (PEK) Schlussbericht. 2005, Swiss Federal Office of Public Health Melchart D, Mitscherlich. F, Amiet M, Eichenberger R, Koch P: Programm Evaluation Komplementärmedizin (PEK) Schlussbericht. 2005, Swiss Federal Office of Public Health
2.
go back to reference White AR, Ernst E: Economic analysis of complementary medicine: a systematic review. Complement Ther Med. 2000, 8 (2): 111-118. 10.1054/ctim.2000.0356.CrossRef White AR, Ernst E: Economic analysis of complementary medicine: a systematic review. Complement Ther Med. 2000, 8 (2): 111-118. 10.1054/ctim.2000.0356.CrossRef
3.
go back to reference Kienle GS, Kiene H: [Does the study "Complementary medicine in health insurance" provide a basis for scientifically valid conclusions?]. Forsch Komplementarmed. 1999, 6 (5): 262-270.PubMed Kienle GS, Kiene H: [Does the study "Complementary medicine in health insurance" provide a basis for scientifically valid conclusions?]. Forsch Komplementarmed. 1999, 6 (5): 262-270.PubMed
4.
go back to reference Sommer JH, Bürgi M, Theiss R: Komplementärmedizin in der Krankenversicherung. Gesundheitsökonomische Analyse der Wirkungen des Einbezugs komplementärmedizinischer Leistungen in die Krankenversicherung. NFP 34. 1998, Basel , EMH Schweizer Ärzteverlag AG, Schweiz Med Wochenschr 1998;128: Suppl. 102. Sommer JH, Bürgi M, Theiss R: Komplementärmedizin in der Krankenversicherung. Gesundheitsökonomische Analyse der Wirkungen des Einbezugs komplementärmedizinischer Leistungen in die Krankenversicherung. NFP 34. 1998, Basel , EMH Schweizer Ärzteverlag AG, Schweiz Med Wochenschr 1998;128: Suppl. 102.
5.
go back to reference Heusser P: Commentary on Sommer et al. 'A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance. Complement Ther Med. 2000, 8 (1): 50-53.CrossRef Heusser P: Commentary on Sommer et al. 'A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance. Complement Ther Med. 2000, 8 (1): 50-53.CrossRef
6.
go back to reference Herman PM, Craig BM, Caspi O: Is complementary and alternative medicine (CAM) cost-effective? A systematic review. BMC Complement Altern Med. 2005, 5: 11-10.1186/1472-6882-5-11.CrossRef Herman PM, Craig BM, Caspi O: Is complementary and alternative medicine (CAM) cost-effective? A systematic review. BMC Complement Altern Med. 2005, 5: 11-10.1186/1472-6882-5-11.CrossRef
7.
go back to reference Herman PM, D'Huyvetter K, Mohler MJ: Are health services research methods a match for CAM?. Altern Ther Health Med. 2006, 12 (3): 78-83.PubMed Herman PM, D'Huyvetter K, Mohler MJ: Are health services research methods a match for CAM?. Altern Ther Health Med. 2006, 12 (3): 78-83.PubMed
8.
go back to reference Jung HP, Wensing M, Grol R: What makes a good general practitioner: do patients and doctors have different views?. Br J Gen Pract. 1997, 47 (425): 805-809.PubMedPubMedCentral Jung HP, Wensing M, Grol R: What makes a good general practitioner: do patients and doctors have different views?. Br J Gen Pract. 1997, 47 (425): 805-809.PubMedPubMedCentral
9.
go back to reference Astin JA: Why patients use alternative medicine: results of a national study. JAMA. 1998, 279 (19): 1548-1553. 10.1001/jama.279.19.1548.CrossRef Astin JA: Why patients use alternative medicine: results of a national study. JAMA. 1998, 279 (19): 1548-1553. 10.1001/jama.279.19.1548.CrossRef
10.
go back to reference Kersnik J: Predictive characteristics of users of alternative medicine. Schweiz Med Wochenschr. 2000, 130 (11): 390-394.PubMed Kersnik J: Predictive characteristics of users of alternative medicine. Schweiz Med Wochenschr. 2000, 130 (11): 390-394.PubMed
12.
go back to reference Andersen RM: Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav. 1995, 36 (1): 1-10. 10.2307/2137284.CrossRef Andersen RM: Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav. 1995, 36 (1): 1-10. 10.2307/2137284.CrossRef
13.
go back to reference Busato A, Donges A, Herren S, Widmer M, Marian F: Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study. Fam Pract. 2005 Busato A, Donges A, Herren S, Widmer M, Marian F: Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study. Fam Pract. 2005
14.
go back to reference Greenfield S, Kaplan SH, Kahn R, Ninomiya J, Griffith JL: Profiling care provided by different groups of physicians: effects of patient case-mix (bias) and physician-level clustering on quality assessment results. Ann Intern Med. 2002, 136 (2): 111-121.CrossRef Greenfield S, Kaplan SH, Kahn R, Ninomiya J, Griffith JL: Profiling care provided by different groups of physicians: effects of patient case-mix (bias) and physician-level clustering on quality assessment results. Ann Intern Med. 2002, 136 (2): 111-121.CrossRef
15.
go back to reference Balint M: The doctor, his patient and the illness. 1957, New York , International University Press Inc.CrossRef Balint M: The doctor, his patient and the illness. 1957, New York , International University Press Inc.CrossRef
16.
go back to reference Rogers CR: The characteristics of a helping relationship. In: On becoming a person: A therapist's view of psychotherapy. 1961, Boston , Houghton Mifflin Rogers CR: The characteristics of a helping relationship. In: On becoming a person: A therapist's view of psychotherapy. 1961, Boston , Houghton Mifflin
17.
go back to reference Levenstein JH, McCracken EC, McWhinney IR, Stewart MA, Brown JB: The patient-centred clinical method. 1. A model for the doctor-patient interaction in family medicine. Fam Pract. 1986, 3 (1): 24-30.CrossRef Levenstein JH, McCracken EC, McWhinney IR, Stewart MA, Brown JB: The patient-centred clinical method. 1. A model for the doctor-patient interaction in family medicine. Fam Pract. 1986, 3 (1): 24-30.CrossRef
18.
go back to reference Mead N, Bower P, Hann M: The impact of general practitioners' patient-centredness on patients' post-consultation satisfaction and enablement. Soc Sci Med. 2002, 55 (2): 283-299. 10.1016/S0277-9536(01)00171-X.CrossRef Mead N, Bower P, Hann M: The impact of general practitioners' patient-centredness on patients' post-consultation satisfaction and enablement. Soc Sci Med. 2002, 55 (2): 283-299. 10.1016/S0277-9536(01)00171-X.CrossRef
19.
go back to reference Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S: Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. Bmj. 2001, 323 (7318): 908-911. 10.1136/bmj.323.7318.908.CrossRef Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S: Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. Bmj. 2001, 323 (7318): 908-911. 10.1136/bmj.323.7318.908.CrossRef
20.
go back to reference Bauman AE, Fardy HJ, Harris PG: Getting it right: why bother with patient-centred care?. Med J Aust. 2003, 179 (5): 253-256.CrossRef Bauman AE, Fardy HJ, Harris PG: Getting it right: why bother with patient-centred care?. Med J Aust. 2003, 179 (5): 253-256.CrossRef
21.
go back to reference Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S: Preferences of patients for patient centred approach to consultation in primary care: observational study. Bmj. 2001, 322 (7284): 468-472. 10.1136/bmj.322.7284.468.CrossRef Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S: Preferences of patients for patient centred approach to consultation in primary care: observational study. Bmj. 2001, 322 (7284): 468-472. 10.1136/bmj.322.7284.468.CrossRef
22.
go back to reference McWhinney IR: Primary care: core values. Core values in a changing world. Bmj. 1998, 316 (7147): 1807-1809.CrossRef McWhinney IR: Primary care: core values. Core values in a changing world. Bmj. 1998, 316 (7147): 1807-1809.CrossRef
23.
go back to reference Jaye C, Tilyard M: A qualitative comparative investigation of variation in general practitioners' prescribing patterns. Br J Gen Pract. 2002, 52 (478): 381-386.PubMedPubMedCentral Jaye C, Tilyard M: A qualitative comparative investigation of variation in general practitioners' prescribing patterns. Br J Gen Pract. 2002, 52 (478): 381-386.PubMedPubMedCentral
24.
go back to reference Watkins C, Harvey I, Carthy P, Moore L, Robinson E, Brawn R: Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey. Qual Saf Health Care. 2003, 12 (1): 29-34. 10.1136/qhc.12.1.29.CrossRef Watkins C, Harvey I, Carthy P, Moore L, Robinson E, Brawn R: Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey. Qual Saf Health Care. 2003, 12 (1): 29-34. 10.1136/qhc.12.1.29.CrossRef
25.
go back to reference Lundkvist J, Akerlind I, Borgquist L, Molstad S: The more time spent on listening, the less time spent on prescribing antibiotics in general practice. Fam Pract. 2002, 19 (6): 638-640. 10.1093/fampra/19.6.638.CrossRef Lundkvist J, Akerlind I, Borgquist L, Molstad S: The more time spent on listening, the less time spent on prescribing antibiotics in general practice. Fam Pract. 2002, 19 (6): 638-640. 10.1093/fampra/19.6.638.CrossRef
26.
go back to reference Freeman GK, Horder JP, Howie JG, Hungin AP, Hill AP, Shah NC, Wilson A: Evolving general practice consultation in Britain: issues of length and context. Bmj. 2002, 324 (7342): 880-882. 10.1136/bmj.324.7342.880.CrossRef Freeman GK, Horder JP, Howie JG, Hungin AP, Hill AP, Shah NC, Wilson A: Evolving general practice consultation in Britain: issues of length and context. Bmj. 2002, 324 (7342): 880-882. 10.1136/bmj.324.7342.880.CrossRef
27.
go back to reference Gill PS, Roalfe A: Determinants of prescribing costs amongst single-handed general practitioners. J Clin Pharm Ther. 2001, 26 (6): 433-435. 10.1046/j.1365-2710.2001.00371.x.CrossRef Gill PS, Roalfe A: Determinants of prescribing costs amongst single-handed general practitioners. J Clin Pharm Ther. 2001, 26 (6): 433-435. 10.1046/j.1365-2710.2001.00371.x.CrossRef
28.
go back to reference Campbell SM, Hann M, Hacker J, Burns C, Oliver D, Thapar A, Mead N, Safran DG, Roland MO: Identifying predictors of high quality care in English general practice: observational study. Bmj. 2001, 323 (7316): 784-787. 10.1136/bmj.323.7316.784.CrossRef Campbell SM, Hann M, Hacker J, Burns C, Oliver D, Thapar A, Mead N, Safran DG, Roland MO: Identifying predictors of high quality care in English general practice: observational study. Bmj. 2001, 323 (7316): 784-787. 10.1136/bmj.323.7316.784.CrossRef
29.
go back to reference SAMW: Ziele und Aufgaben der Medizin zu Beginn des 21. Jahrhunderts. 2004, Schweizerische Akademie der Medizinischen Wissenschaften SAMW: Ziele und Aufgaben der Medizin zu Beginn des 21. Jahrhunderts. 2004, Schweizerische Akademie der Medizinischen Wissenschaften
30.
go back to reference MEDICINE INSTITUTEOF: Crossing the Quality Chasm: A New Health System for the 21st Century (2001). 2001, NATIONAL ACADEMY PRESS;Washington, D.C MEDICINE INSTITUTEOF: Crossing the Quality Chasm: A New Health System for the 21st Century (2001). 2001, NATIONAL ACADEMY PRESS;Washington, D.C
Metadata
Title
Extent and structure of health insurance expenditures for complementary and alternative medicine in Swiss primary care
Authors
Andre Busato
Reiner Eichenberger
Beat Künzi
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2006
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-6-132

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