Abstract
The aim of the study was to analyse the effects of supplementary health insurance on the incidence of hospitalisations for musculoskeletal conditions in Switzerland. Cross sectional and small area analyses of surgical interventions for major musculoskeletal disorders in Switzerland were conducted. The regional distributions of populations with basic and basic plus supplementary insurance were estimated using census data for the period of 2002-2005. Effects of insurance class on the incidence of orthopaedic interventions were calculated with logistic regression using the complete discharge dataset of hospitalisations for orthopaedic conditions performed in the years 2002 to 2005. The data show significant differences in the age- and gender-adjusted incidence of surgery between populations with compulsory basic health insurance and those with basic plus supplementary cover. The study provides evidence that health insurance status accounts for variation in surgery for musculoskeletal problems in Switzerland. There are indications that supplementary health insurance - as a proxy for higher socioeconomic status - is related to lower need for surgery. There are signs that resources for spinal surgery and arthroscopy are diverted to the private sector at the expense of social health insurance. The results are only partially consistent with the hypothesis that volume of services increases with comprehensiveness of coverage.
Highlights
Previous work has shown wide regional variations for major orthopaedic surgical procedures in Switzerland [1], and the available data, along with other observations [2], suggest that variation in use of resources is associated with redundancy and inefficiency
The proportion of the population covered only by basic health insurance increased from 70.4% in 2002 to 73.5% in 2005 and the proportion with supplementary insurance was higher for women
On average the population with supplementary insurance was considerably older than the population with basic health insurance
Summary
Previous work has shown wide regional variations for major orthopaedic surgical procedures in Switzerland [1], and the available data, along with other observations [2], suggest that variation in use of resources is associated with redundancy and inefficiency. Mandatory health insurance provided by authorised and competing insurance companies covers a standardised basic benefit package that includes a wide range of health services. By law there is open enrolment, premiums must be identical for all risk groups for a given deductible, and insurers are not allowed to make profits. Premiums and eligibility for supplementary coverage are conditional on risk status, there is no obligation to enroll and insurers can make profits in this market segment. Such additional products cover better levels of accommodation, more choice of physicians in hospitals and guaranteed access to almost all private and public hospitals in Switzerland.
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