Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 148 No. 4344 (2018)

Impact of alternative healthcare plans on out-of-hours help-seeking intentions in Switzerland

  • Ellen Keizer
  • Linda Huibers
  • Morten Bondo Christensen
  • Oliver Senn
DOI
https://doi.org/10.4414/smw.2018.14686
Cite this as:
Swiss Med Wkly. 2018;148:w14686
Published
30.10.2018

Summary

INTRODUCTION

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.

AIM

To examine the impact of alternative HCPs on patients’ intended help-seeking behaviour out-of-hours (OOH) in Switzerland.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

References

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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)
  17. Berchtold P, Peytremann-Bridevaux I. Integrated care organizations in Switzerland. Int J Integr Care. 2011;11 Spec Ed:e010.
  18. 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.
  19. Mossialos E, Wenzl M, Osborn R, Anderson C. International Profiles Of Health Care Systems, 2014. The Commonwealth Fund; 2015.
  20. 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.
  21. 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.
  22. 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
  23. 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
  24. 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
  25. European research network for out-of-hours primary health care. Available from: www.euroohnet.eu.
  26. Respondi consumer panel [Available from: www.respondi.com.
  27. Bilendi consumer panel [Available from: www.bilendi.co.uk/static/studymarket.
  28. 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
  29. 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
  30. 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
  31. 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.
  32. 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
  33. 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
  34. 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
  35. 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
  36. Federal Statistical Office. [Available from: https://www.bfs.admin.ch/bfs/en/home/statistics/population.html.
  37. 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
  38. 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
  39. 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.
  40. 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

Most read articles by the same author(s)

1 2 > >>