Factors related to treatment intensity in Swiss primary care Export

@article{citeulike:4194192, abstract = {BACKGROUND:Questions about the existence of supplier-induced demand emerge repeatedly in discussions about governing Swiss health care. This study therefore aimed to evaluate the interrelationship between structural factors of supply and the volume of services that are provided by primary care physicians in Switzerland.METHODS:The study was designed as a cross-sectional investigation, based on the complete claims data from all Swiss health care insurers for the year 2004, which covered information from 6087 primary care physicians and 4.7 million patients. Utilization-based health service areas were constructed and used as spatial units to analyze effects of density of supply. Hierarchical linear models were applied to analyze the data. RESULTS:The data showed that, within a service area, a higher density of primary care physicians was associated with higher mortality rates and specialist density but not with treatment intensity in primary care. Higher specialist density was weakly associated with higher mortality rates and with higher treatment intensity density of primary care physicians. Annual physician-level data indicate a disproportionate increase of supplied services irrespective of the size of the number of patients treated during the same year and, even in high volume practices, no rationing but a paradoxical inducement of consultations occurred. The results provide empirical evidence that higher densities of primary care physicians, specialists and the availability of out-patient hospital clinics in a given area are associated with higher volume of supplied services per patient in primary care practices. Analyses stratified by language regions showed differences that emphasize the effect of the cantonal based (fragmented) governance of Swiss health care.CONCLUSIONS:The study shows high volumes in Swiss primary care and provides evidence that the volume of supply is not driven by medical needs alone. Effects related to the competition for patients between primary care physicians, specialists and out-patient hospital clinics and an association with the system of reimbursing services on a fee-for-service basis can not be excluded.}, author = {Busato, Andre and Matter, Pius and Kunzi, Beat}, citeulike-article-id = {4194192}, citeulike-linkout-0 = {http://dx.doi.org/10.1186/1472-6963-9-49}, doi = {10.1186/1472-6963-9-49}, issn = {1472-6963}, journal = {BMC Health Services Research}, keywords = {care, demand, density, health, hospital, induced, intensity, list, patient, physician, pid, primary, sid, supply, swiss, treatment}, number = {1}, pages = {49+}, posted-at = {2009-03-19 07:31:19}, priority = {2}, title = {Factors related to treatment intensity in Swiss primary care}, url = {http://dx.doi.org/10.1186/1472-6963-9-49}, volume = {9}, year = {2009} }

TY - JOUR ID - citeulike:4194192 L3 - citeulike-article-id:4194192 N2 - BACKGROUND:Questions about the existence of supplier-induced demand emerge repeatedly in discussions about governing Swiss health care. This study therefore aimed to evaluate the interrelationship between structural factors of supply and the volume of services that are provided by primary care physicians in Switzerland.METHODS:The study was designed as a cross-sectional investigation, based on the complete claims data from all Swiss health care insurers for the year 2004, which covered information from 6087 primary care physicians and 4.7 million patients. Utilization-based health service areas were constructed and used as spatial units to analyze effects of density of supply. Hierarchical linear models were applied to analyze the data. RESULTS:The data showed that, within a service area, a higher density of primary care physicians was associated with higher mortality rates and specialist density but not with treatment intensity in primary care. Higher specialist density was weakly associated with higher mortality rates and with higher treatment intensity density of primary care physicians. Annual physician-level data indicate a disproportionate increase of supplied services irrespective of the size of the number of patients treated during the same year and, even in high volume practices, no rationing but a paradoxical inducement of consultations occurred. The results provide empirical evidence that higher densities of primary care physicians, specialists and the availability of out-patient hospital clinics in a given area are associated with higher volume of supplied services per patient in primary care practices. Analyses stratified by language regions showed differences that emphasize the effect of the cantonal based (fragmented) governance of Swiss health care.CONCLUSIONS:The study shows high volumes in Swiss primary care and provides evidence that the volume of supply is not driven by medical needs alone. Effects related to the competition for patients between primary care physicians, specialists and out-patient hospital clinics and an association with the system of reimbursing services on a fee-for-service basis can not be excluded. IS - 1 JF - BMC Health Services Research SN - 1472-6963 TI - Factors related to treatment intensity in Swiss primary care VL - 9 SP - 49 KW - care KW - demand KW - density KW - health KW - hospital KW - induced KW - intensity KW - list KW - patient KW - physician KW - pid KW - primary KW - sid KW - supply KW - swiss KW - treatment AU - Busato, Andre AU - Matter, Pius AU - Kunzi, Beat PY - 2009/// UR - http://dx.doi.org/10.1186/1472-6963-9-49 ER -