Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland

André Busato,Beat Künzi

doi:10.1186/1472-6963-8-8

Abstract

BackgroundThe Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland.MethodsThe data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data.ResultsModels within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care.ConclusionThe study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds of the served populations.

Highlights

The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers
The data obtained from the pool of Swiss health insurers included the complete records of the 21'413'299 consultations of all 6564 Swiss primary care physicians with patients throughout Switzerland that were reimbursed by compulsory health insurance in 2004
These primary care data accounted for 39.5% of all ambulatory care physicians and 56.5% of all ambulatory consultations reimbursed by basic health insurance

Summary

Introduction

The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. Such findings may have contributed to a governmental decision to freeze new accreditations for physicians in private practice in Switzerland[3] This legislation is based on the assumption that demand-induced health care spending may be cut by limiting the associated care offers, a policy that initiated a controversial public debate in Switzerland. The purpose of this article is to provide estimates of resource utilisation in Swiss primary care and to determine relevant factors in this context

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Discussion

Conclusion