Figure 1.
Proportion of population in an integrated care model per annum.
Figure 2.
Distribution of cost ratio per model (left) and distribution of logarithmic cost ratio per model (right) Black: Basic compulsory insurance; red: A) capitation models; green: B1) family doctor model; blue: B2) telemedicine model.
Table 1.
Sample characteristics on variables
| Basic compulsory insurance model with free choice of provider | A) Contracted models with capitation | B) Contracted models without capitation | ||
|---|---|---|---|---|
| B1) Family doctor model | B2) Telemedicine model | |||
| i | 1,430,704 | 20,336 | 45,976 | 100,080 |
| t | 2006–2009 | 2006–2009 | 2006–2009 | 2006–2009 |
| N | 357,676 | 5084 | 11,494 | 25,020 |
| Cost ratio total costs mean | 1.535 | 1.079 | 1.211 | 1.190 |
| Std. dev. | 3.737 | 2.265 | 3.038 | 2.706 |
| Age groups | ||||
| 0–18 years | 12.60% | 6.88% | 6.95% | 10.77% |
| 19–25 years | 4.52% | 3.63% | 4.14% | 4.90% |
| 26–30 years | 2.75% | 2.67% | 1.57% | 2.72% |
| 31–35 years | 3.45% | 3.57% | 1.57% | 3.54% |
| 36–40 years | 4.33% | 4.89% | 2.44% | 4.61% |
| 41–45 years | 5.54% | 6.32% | 4.29% | 5.92% |
| 46–50 years | 6.14% | 7.14% | 5.69% | 6.75% |
| 51–55 years | 6.96% | 6.90% | 6.93% | 8.31% |
| 56–60 years | 8.31% | 7.34% | 8.57% | 10.20% |
| 61–65 years | 9.20% | 8.78% | 9.97% | 11.62% |
| 66–70 years | 8.60% | 8.90% | 10.75% | 9.45% |
| 71–75 years | 8.75% | 10.68% | 11.96% | 8.43% |
| 76–80 years | 8.15% | 10.58% | 11.23% | 6.39% |
| 81–85 years | 6.20% | 7.47% | 8.50% | 4.20% |
| 86–90 years | 3.24% | 3.25% | 4.02% | 1.69% |
| 91-years | 1.26% | 0.99% | 1.42% | 0.49% |
| Deductible class (>500 Swiss francs) | 9.76% | 17.89% | 10.24% | 28.60% |
| Hospital stay | 13.01% | 11.28% | 13.00% | 10.69% |
| Nursing home stay | 3.05% | 1.79% | 3.48% | 1.09% |
| Accident coverage | 23.25% | 29.22% | 23.65% | 31.50% |
| Chronic patient | ||||
| Nq500 | ||||
| 0 quarter | 25.83% | 29.62% | 26.67% | 31.32% |
| 1 quarter | 19.60% | 21.37% | 20.68% | 22.41% |
| 2 quarters | 15.77% | 16.73% | 16.51% | 16.11% |
| 3 quarters | 14.86% | 14.29% | 15.05% | 13.68% |
| 4 quarters | 23.94% | 17.98% | 21.09% | 16.49% |
| Female | 60.43% | 58.88% | 59.81% | 59.68% |
| Cost ratio preceding year classes | ||||
| 1 | 4.63% | 6.28% | 4.44% | 6.48% |
| 2 | 4.68% | 5.51% | 4.79% | 5.82% |
| 3 | 4.69% | 5.39% | 4.92% | 5.61% |
| 4 | 4.71% | 5.31% | 4.84% | 5.41% |
| 5 | 4.71% | 5.38% | 5.04% | 5.21% |
| 6 | 4.72% | 4.98% | 5.03% | 5.14% |
| 7 | 4.73% | 4.85% | 5.07% | 5.00% |
| 8 | 4.73% | 4.79% | 5.27% | 4.98% |
| 9 | 4.75% | 4.80% | 4.84% | 4.87% |
| 10 | 4.75% | 4.50% | 4.89% | 4.87% |
| 11 | 4.76% | 4.55% | 4.91% | 4.73% |
| 12 | 4.77% | 4.54% | 4.86% | 4.70% |
| 13 | 4.79% | 4.43% | 4.56% | 4.57% |
| 14 | 4.79% | 4.59% | 4.74% | 4.40% |
| 15 | 4.80% | 4.55% | 4.69% | 4.26% |
| 16 | 4.80% | 4.39% | 4.64% | 4.42% |
| 17 | 4.82% | 4.28% | 4.47% | 4.17% |
| 18 | 4.83% | 3.97% | 4.40% | 4.15% |
| 19 | 4.83% | 4.48% | 4.59% | 3.95% |
| 20 | 4.84% | 4.26% | 4.65% | 3.81% |
| 21 | 1.21% | 1.02% | 1.25% | 0.88% |
| 22 | 1.22% | 1.04% | 1.04% | 0.89% |
| 23 | 1.22% | 1.01% | 1.03% | 0.90% |
| 24 | 1.23% | 1.06% | 1.05% | 0.76% |
Table 2.
Econometric results
| Variable | Mixed-effects model Coefficient [95% CI] | Std. Err. | Effect in per centa |
|---|---|---|---|
| Hospital stay (HOSP) | 0.959 [0.955; 0.962]*** | 0.002 | 160.8% |
| Nursing home stay (NURS) | 0.241 [0.233; 0.250]*** | 0.004 | 27.3% |
| Insurance plan (PLAN) | |||
| Capitated model (CAP) | –0.239 [–0.257; –0.221]*** | 0.009 | –21.2% |
| Family doctor model (FDM) | –0.169 [–0.182; –0.157]*** | 0.006 | –15.5% |
| Telemedicine model (TEL) | –0.038 [–0.046; –0.029]*** | 0.004 | –3.7% |
| Cost ratio preceding year (CRPY) | |||
| Class 2 | –0.108 [–0.114; –0.101]*** | 0.003 | –10.2% |
| Class 3 | –0.126 [–0.134; –0.120]*** | 0.003 | –11.9% |
| Class 4 | –0.122 [–0.129; –0.115]*** | 0.003 | –11.5% |
| Class 5 | –0.110 [–0.117; –0.103]*** | 0.003 | –10.4% |
| Class 6 | –0.101 [–0.108; –0.094]*** | 0.003 | –9.6% |
| Class 7 | –0.090 [–0.098; –0.083]*** | 0.003 | –8.7% |
| Class 8 | –0.082 [–0.089; –0.076]*** | 0.003 | –7.9% |
| Class 9 | –0.068 [–0.075; –0.061]*** | 0.003 | –6.5% |
| Class 10 | –0.058 [–0.065; –0.051]*** | 0.004 | –5.6% |
| Class 11 | –0.039 [–0.046; –0.033]*** | 0.004 | –3.9% |
| Class 12 | –0.033 [–0.040; –0.026]*** | 0.004 | –3.2% |
| Class 13 | –0.017 [–0.024; –0.010]*** | 0.004 | –1.7% |
| Class 14 | –0.004 [–0.011; 0.003] | 0.004 | –0.4% |
| Class 15 | 0.018 [0.011; 0.025]*** | 0.004 | 1.8% |
| Class 16 | 0.043 [0.036; 0.050]*** | 0.004 | 4.4% |
| Class 17 | 0.064 [0.056; 0.070]*** | 0.004 | 6.6% |
| Class 18 | 0.094 [0.087; 0.101]*** | 0.004 | 9.9% |
| Class 19 | 0.131 [0.124; 0.138]*** | 0.004 | 14.0% |
| Class 20 | 0.208 [0.200; 0.214]*** | 0.004 | 23.1% |
| Class 21 | 0.300 [0.289; 0.310]*** | 0.006 | 35.0% |
| Class 22 | 0.382 [0.371; 0.393]*** | 0.006 | 46.5% |
| Class 23 | 0.513 [0.501; 0.524]*** | 0.006 | 67.0% |
| Class 24 | 0.786 [0.773; 0.798]*** | 0.006 | 119.4% |
| Accident coverage (ACC) | 0.219 [0.215; 0.223]*** | 0.002 | 24.5% |
| Chronic patients (CHRO) | |||
| 1 Quarter (CHRO1) | 1.121 [1.118; 1.125]*** | 0.002 | 206.9% |
| 2 Quarters (CHRO2) | 1.562 [1.558; 1.565]*** | 0.002 | 376.8% |
| 3 Quarters (CHRO3) | 1.861 [1.857; 1.865]*** | 0.002 | 542.8% |
| 4 Quarters (CHRO4) | 2.150 [2.156; 2.154]*** | 0.002 | 758.4% |
| Deductible class (DED) | –0.151 [–0.157; –0.145]*** | 0.003 | –14% |
| Constant | –1.845 [–1.852; –1.839]*** | 0.003 | –84.2% |
| Random effects Std. Err. | |||
| Between group error | 0.6075 | ||
| Within group error | 0.5651 |
[i] *p<0.10, **p<0.05, ***p<0.01
a)The regression analysis determines the regression coefficient β of each independent variable. In order to obtain the impact in percent of the dummy variables, the following further transformation of the coefficients is applied exp(β) – 1
Table 3.
Calculation of the different effects by insurance model
| Effect | A. Contracted models with capitation | B1. Contracted models without capitation | 3B2. Telemedicine models |
|---|---|---|---|
| Overall average cost savings | –29.7% | –21.1% | –22.5% |
| There from efficiency effects | –21.2% | –15.5% | –3.7% |
| There from selection effects | –8.5% | –5.6% | –18.8% |
Table 4.
Comparison of cost ratios per pharmacy cost group by insurance model
| Pharmacy cost group | Basic compulsory insurance model (Cost ratio mean) | A. Contracted models with capitation (Cost ratio mean and difference in percent from basic insurance) | B1. Contracted models without capitation (Cost ratio mean and difference in percent from basic insurance) | B2. Telemedicine models (Cost ratio mean and difference in percent from basic insurance) |
|---|---|---|---|---|
| PCG1 | 2.010 | 1.383 | 1.630 | 1.761 |
| Asthma/COPD | –31.2% | –18.9% | –12.4% | |
| PCG4 | 2.030 | 1.508 | 1.652 | 1.884 |
| Cardiac disorders | –25.7% | –18.6% | –7.2% | |
| PCG6 | 2.397 | 1.695 | 1.979 | 2.087 |
| Gastric disorders | –29.3% | –17.4% | –12.9% | |
| PCG11 | 1.675 | 1.224 | 1.467 | 1.427 |
| Diabetes type II | –27.0% | –12.5% | –14.8% |