Impact of alternative healthcare plans on out-of-hours help-seeking intentions in Switzerland
In Switzerland, mandatory health insurance plans (standard) offer free access to secondary and emergency care. However, in return for a lower premium, individuals can choose alternative healthcare plans (HCPs), with either a general practitioner (GP) or a medical call centre (Telmed) acting as gatekeeper.
To examine the impact of alternative HCPs on patients’ intended help-seeking behaviour out-of-hours (OOH) in Switzerland.
A secondary analysis of the Swiss data collected for the EurOOHnet survey on help-seeking behaviour in Denmark, the Netherlands and Switzerland was made. The survey used hypothetical scenarios for measuring two outcome measures: intended help-seeking for (1) OOH care and (2) OOH face-to-face care. Binomial regression analyses were used to test the influence of HCPs on intended OOH help-seeking, adjusted for other (population) characteristics.
Telmed-insured persons were more inclined to OOH help-seeking than persons with a standard HCP (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.91–2.72; controlled for other population factors), mainly driven by contact with the medical call centre (31 vs 5%), and were less inclined to have an OOH face-to-face contact (OR 0.69, 95% CI 0.55–0.87). Persons with a GP HCP had a lower intended use of face-to-face OOH care contacts than persons with a standard plan (OR 0.74, 95% CI 0.63–0.86).
Alternative HCPs on a voluntary basis seem to influence the use of OOH care. These results could be relevant for policy makers, especially from non-gatekeeping countries, to reduce irrelevant use and subsequent costs of emergency and OOH care services.
- Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Al Shabanah H, Anderson PD, et al. International perspectives on emergency department crowding. Acad Emerg Med. 2011;18(12):1358–70. doi:.https://doi.org/10.1111/j.1553-2712.2011.01235.x
- Carter EJ, Pouch SM, Larson EL. The relationship between emergency department crowding and patient outcomes: a systematic review. J Nurs Scholarsh. 2014;46(2):106–15. doi:.https://doi.org/10.1111/jnu.12055
- Smits M, Keizer E, Huibers L, Giesen P. GPs’ experiences with out-of-hours GP cooperatives: a survey study from the Netherlands. Eur J Gen Pract. 2014;20(3):196–201. doi:.https://doi.org/10.3109/13814788.2013.839652
- Johnson KD, Winkelman C. The effect of emergency department crowding on patient outcomes: a literature review. Adv Emerg Nurs J. 2011;33(1):39–54. doi:.https://doi.org/10.1097/TME.0b013e318207e86a
- Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126–36.e1. doi:.https://doi.org/10.1016/j.annemergmed.2008.03.014
- Tekwani KL, Kerem Y, Mistry CD, Sayger BM, Kulstad EB. Emergency Department Crowding is Associated with Reduced Satisfaction Scores in Patients Discharged from the Emergency Department. West J Emerg Med. 2013;14(1):11–5. doi:.https://doi.org/10.5811/westjem.2011.11.11456
- Durand AC, Gentile S, Devictor B, Palazzolo S, Vignally P, Gerbeaux P, et al. ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. Am J Emerg Med. 2011;29(3):333–45. doi:.https://doi.org/10.1016/j.ajem.2010.01.003
- Chmiel C, Wang M, Sidler P, Eichler K, Rosemann T, Senn O. Implementation of a hospital-integrated general practice--a successful way to reduce the burden of inappropriate emergency-department use. Swiss Med Wkly. 2016;146:w14284. doi:.https://doi.org/10.4414/smw.2016.14284
- Thijssen WA, van Mierlo E, Willekens M, Rebel J, Sandel MH, Giesen P, et al. Complaints and Diagnoses of Emergency Department Patients in the Netherlands: A Comparative Study of Integrated Primary and Emergency Care. PLoS One. 2015;10(7):e0129739. doi:.https://doi.org/10.1371/journal.pone.0129739
- Keizer E, Smits M, Peters Y, Huibers L, Giesen P, Wensing M. Contacts with out-of-hours primary care for nonurgent problems: patients’ beliefs or deficiencies in healthcare? BMC Fam Pract. 2015;16(1):157. doi:.https://doi.org/10.1186/s12875-015-0376-9
- Sanchez B, Hirzel AH, Bingisser R, Ciurea A, Exadaktylos A, Lehmann B, et al. State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006. Int J Emerg Med. 2013;6(1):23. doi:.https://doi.org/10.1186/1865-1380-6-23
- Diserens L, Egli L, Fustinoni S, Santos-Eggimann B, Staeger P, Hugli O. Emergency department visits for non-life-threatening conditions: evolution over 13 years in a Swiss urban teaching hospital. Swiss Med Wkly. 2015;145:w14123. doi:.https://doi.org/10.4414/smw.2015.14123
- Niemann S, Meer A, Simonin C, Abel T. Medical telephone triage and patient behaviour: How do they compare? Swiss Med Wkly. 2004;134(9-10):126–31. doi:.https://doi.org/10.4414/smw.2004.10276
- van den Berg MJ, van Loenen T, Westert GP. Accessible and continuous primary care may help reduce rates of emergency department use. An international survey in 34 countries. Fam Pract. 2016;33(1):42–50. doi:.https://doi.org/10.1093/fampra/cmv082
- Huibers L, Keizer E, Helles Carlsen A, Moth G, Smits M, Senn O, et al. Help-seeking behaviour outside office hours in Denmark, the Netherlands, and Switzerland: : a questionnaire study exploring responses to hypothetical cases. BMJ Open. 2018;8:e019295. doi:.https://doi.org/10.1136/bmjopen-2017-019295
- Keizer E, Bondo Christensen M, Helles Carlsen A, Smits M, Wensing M, Senn O, et al. Factors related to out-of-hours help-seeking for acute health problems: a survey study using case scenarios. 2018. (Submitted)
- Berchtold P, Peytremann-Bridevaux I. Integrated care organizations in Switzerland. Int J Integr Care. 2011;11 Spec Ed:e010.
- De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, et al. Switzerland: Health System Review. Health Syst Transit. 2015;17(4):1–288, xix.
- Mossialos E, Wenzl M, Osborn R, Anderson C. International Profiles Of Health Care Systems, 2014. The Commonwealth Fund; 2015.
- Berchet C, Nader C. The organisation of out-of-hours primary care in OECD countries”, OECD Health Working Papers, No. 89. Paris: OECD Publishing; 2016.
- Forum Managesd Care. Erhebung Ärztenetze in der Schweiz [Collection of medical networks in Switzerland] 2015 [18-11-2017]. Available from: http://fmc.ch/infothek/erhebung-aerztenetze.
- Huber CA, Reich O, Früh M, Rosemann T. Effects of Integrated Care on Disease-Related Hospitalisation and Healthcare Costs in Patients with Diabetes, Cardiovascular Diseases and Respiratory Illnesses: A Propensity-Matched Cohort Study in Switzerland. Int J Integr Care. 2016;16(1):11. doi:.https://doi.org/10.5334/ijic.2455
- Reich O, Rosemann T, Rapold R, Blozik E, Senn O. Potentially inappropriate medication use in older patients in Swiss managed care plans: prevalence, determinants and association with hospitalization. PLoS One. 2014;9(8):e105425. doi:.https://doi.org/10.1371/journal.pone.0105425
- Damery S, Flanagan S, Combes G. Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews. BMJ Open. 2016;6(11):e011952. doi:.https://doi.org/10.1136/bmjopen-2016-011952
- European research network for out-of-hours primary health care. Available from: www.euroohnet.eu.
- Respondi consumer panel [Available from: www.respondi.com.
- Bilendi consumer panel [Available from: www.bilendi.co.uk/static/studymarket.
- Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10. doi:.https://doi.org/10.2307/2137284
- Smits M, Hanssen S, Huibers L, Giesen P. Telephone triage in general practices: A written case scenario study in the Netherlands. Scand J Prim Health Care. 2016;34(1):28–36. doi:.https://doi.org/10.3109/02813432.2016.1144431
- Giesen P, Ferwerda R, Tijssen R, Mokkink H, Drijver R, van den Bosch W, et al. Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency? Qual Saf Health Care. 2007;16(3):181–4. doi:.https://doi.org/10.1136/qshc.2006.018846
- Huibers L, Sloot S, Giesen P, van Veen M, van Ierland Y, Moll H. Wetenschappelijk onderzoek Nederlands Triage Systeem [Scientific Research Netherlands Triage System]. Nijmegen, Rotterdam: IQ healthcare Radboudumc, Erasmus MC Sophia Kinderziekenhuis; 2009.
- Bes RE, Curfs EC, Groenewegen PP, de Jong JD. Health plan choice in the Netherlands: restrictive health plans preferred by young and healthy individuals. Health Econ Policy Law. 2017;12(3):345–62. doi:.https://doi.org/10.1017/S1744133116000517
- Nicholas LH. Better Quality of Care or Healthier Patients? Hospital Utilization by Medicare Advantage and Fee-for-Service Enrollees. Forum Health Econ Policy. 2013;16(1):137–61. doi:.https://doi.org/10.1515/fhep-2012-0037
- Selevan J, Kindermann D, Pines JM, Fields WW. What Accountable Care Organizations Can Learn from Kaiser Permanente California’s Acute Care Strategy. Popul Health Manag. 2015;18(4):233–6. doi:.https://doi.org/10.1089/pop.2014.0157
- Van den Heede K, Van de Voorde C. Interventions to reduce emergency department utilisation: A review of reviews. Health Policy. 2016;120(12):1337–49. doi:.https://doi.org/10.1016/j.healthpol.2016.10.002
- Federal Statistical Office. [Available from: https://www.bfs.admin.ch/bfs/en/home/statistics/population.html.
- Armitage CJ, Conner M. Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol. 2001;40(Pt 4):471–99. doi:.https://doi.org/10.1348/014466601164939
- Newbould J, Abel G, Ball S, Corbett J, Elliott M, Exley J, et al. Evaluation of telephone first approach to demand management in English general practice: observational study. BMJ. 2017;358:j4197. doi:.https://doi.org/10.1136/bmj.j4197
- Giesen P, Hammink A, Mulders A, Oude Bos A. Te snel naar de huisartsenpost [Too easy to go to the GP cooperative]. Med Contact (Bussum). 2009;06:239–42.
- Huibers L, Moth G, Andersen M, van Grunsven P, Giesen P, Christensen MB, et al. Consumption in out-of-hours health care: Danes double Dutch? Scand J Prim Health Care. 2014;32(1):44–50. doi:.https://doi.org/10.3109/02813432.2014.898974