Introduction
Theory and background of the swiss health system
Theoretical expectations
Doctors’ admissions and cost containment in Switzerland
Materials and methods
Dataset on healthcare spending in Switzerland
sasis.ch
). We can observe the number of doctors billing in free practice and the health costs by specialty in each canton over the period 2007-2018 on a monthly basis (144 months). The records are based on registration numbers identifying independent practitioners and legal entities, which bill medical services to health insurers (“Zahlstellenregister” numbers, ZSR). Our data count the number of unique ZSR billings, in each month and canton by specialty. These data measure the medical claims billed by the ZSR under the KVG. Other healthcare services, such as pharmaceuticals and hospital services are billed using another identifier (see sasis.ch
). The benefits paid by all health insurers in Switzerland are recorded by SASIS. Through the ZSR, our data inform about the number of independent SP and GP as well as the direct health costs they create over time. Our data show that the number of doctors billing in free practice and the related health costs have increased for both SP and GP (also see the graphs in the supplementary materials part A). The seasonal effects appear since doctors tend to send their invoices to insurers at the end of each billing period.1 We provide further information on the data and descriptive statistics in the supplementary materials (parts A and B).Method of analysis
Results
Removal of the national moratorium for sP and gP
Number of SP billing in free practice | Health costs from SP | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Intercept | Month | Rem. | Month×Rem. | Intercept | Month | Rem. | Month×Rem. | |||||||||
AG | 7.946 | *** | .022 | *** | −.224 | * | .035 | *** | 16.751 | *** | .050 | *** | .343 | −.020 | * | |
AI | 5.429 | *** | .026 | *** | −.469 | −.015 | 12.842 | *** | .030 | *** | .508 | −.038 | ||||
AR | 6.136 | *** | .023 | *** | −.686 | *** | .018 | 14.233 | *** | .022 | *** | .216 | .015 | |||
BE | 7.841 | *** | .017 | *** | −.278 | * | .033 | *** | 17.351 | *** | .039 | *** | .570 | *** | −.014 | |
BL | 7.081 | *** | .017 | *** | −.216 | .030 | ** | 16.331 | *** | .024 | *** | .077 | .063 | ** | ||
BS | 6.932 | *** | .003 | * | −.261 | ** | .049 | *** | 15.918 | *** | .023 | *** | .172 | .020 | ||
FR | 7.435 | *** | .030 | *** | −.276 | * | .040 | *** | 16.140 | *** | .049 | *** | .032 | .007 | ||
GE | 7.318 | *** | .008 | *** | .226 | * | .069 | *** | 17.033 | *** | .028 | *** | .438 | .041 | ||
GL | 5.985 | *** | .031 | *** | .097 | −.030 | 13.835 | *** | .027 | *** | .423 | −.094 | ** | |||
GR | 6.997 | *** | .027 | *** | −.536 | *** | .061 | *** | 15.347 | *** | .034 | *** | .319 | .009 | ||
JU | 6.254 | *** | .022 | *** | −.028 | .042 | * | 14.518 | *** | .047 | *** | −.195 | .081 | ** | ||
LU | 7.209 | *** | −.008 | .167 | .059 | *** | 16.087 | *** | .013 | *** | 1.081 | *** | −.009 | |||
NE | 6.654 | *** | .020 | *** | −.094 | .044 | ** | 15.526 | *** | .011 | * | .773 | .014 | |||
NW | 6.017 | *** | .007 | * | .150 | −.010 | 13.861 | *** | .032 | *** | .184 | .037 | ||||
OW | 5.754 | *** | .019 | *** | −.013 | .018 | 13.515 | *** | .054 | *** | .739 | ** | −.029 | |||
SG | 7.438 | *** | .016 | *** | −.131 | .046 | *** | 16.582 | *** | .036 | *** | .488 | * | −.005 | ||
SH | 6.395 | *** | .033 | *** | −.366 | .049 | *** | 14.856 | *** | .039 | *** | .867 | * | −.065 | *** | |
SO | 7.467 | *** | .023 | *** | −.256 | ** | .032 | *** | 16.024 | *** | .032 | *** | .380 | .002 | ||
SZ | 7.227 | *** | .028 | *** | −.210 | .031 | ** | 15.393 | *** | .033 | *** | .596 | * | −.028 | ||
TG | 7.107 | *** | .024 | *** | −.154 | .020 | 15.707 | *** | .040 | *** | .772 | −.007 | ||||
TI | 6.934 | *** | .024 | *** | −.097 | .037 | ** | 16.320 | *** | .026 | *** | .313 | .023 | |||
UR | 5.643 | *** | .024 | *** | .183 | −.047 | ** | 13.844 | *** | .082 | *** | −.030 | −.197 | *** | ||
VD | 7.818 | *** | .024 | *** | −.010 | .023 | *** | 17.149 | *** | .041 | *** | .474 | * | −.005 | ||
VS | 7.430 | *** | .032 | *** | −.071 | .019 | 16.086 | *** | .049 | *** | .130 | −.011 | ||||
ZG | 6.887 | *** | .017 | *** | .050 | .029 | *** | 15.254 | *** | .027 | *** | .326 | * | .006 | ||
ZH | 8.175 | *** | .012 | *** | −.213 | * | .053 | *** | 17.974 | *** | .037 | *** | .447 | −.039 | * | |
CH | 19.499 | *** | .035 | *** | .052 | .021 |
Reintroduction of cantonal moratoriums for sP
Intercept | Month | Reint. | Month×Reint. | |||
---|---|---|---|---|---|---|
Results for number of SP billing in free practice | ||||||
4.362 | *** | .002 | *** | −.522 | *** | −.000 |
Results for health costs from SP | ||||||
19.791 | *** | .002 | ** | −.603 | *** | .000 |
Number of SP billing in free practice | Health costs from SP | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Intercept | Month | Reint. | Month×Reint. | Intercept | Month | Reint. | Month×Reint. | |||||||||
BE | 7.954 | *** | .059 | *** | .031 | −.038 | *** | 17.523 | *** | .065 | *** | .181 | −.031 | * | ||
BL | 7.165 | *** | .053 | *** | .315 | *** | −.035 | *** | 16.526 | *** | .101 | *** | −.003 | −.077 | *** | |
BS | 7.013 | *** | .057 | *** | .278 | * | −.043 | *** | 16.052 | *** | .086 | *** | −.128 | −.065 | ** | |
GE | 7.528 | *** | .065 | *** | .014 | −.051 | *** | 17.244 | *** | .066 | *** | .343 | −.036 | ** | ||
GL | 5.988 | *** | −.008 | .926 | *** | .036 | *** | 13.764 | *** | −.039 | 1.521 | *** | .064 | ** | ||
LU | 7.322 | *** | .049 | *** | .480 | *** | −.019 | ** | 16.226 | *** | .037 | .404 | .002 | |||
NE | 6.758 | *** | .043 | ** | .466 | ** | −.021 | 15.670 | *** | .043 | 1.078 | *** | .019 | |||
NW | 6.021 | *** | −.011 | .646 | *** | .041 | *** | 13.998 | *** | .078 | *** | −.350 | −.040 | |||
OW | 5.812 | *** | .028 | .472 | * | .002 | 13.618 | *** | .027 | .240 | .028 | |||||
SG | 7.531 | *** | .056 | *** | .533 | *** | −.034 | *** | 16.688 | *** | .048 | *** | .952 | *** | −.020 | |
SH | 6.494 | *** | .070 | *** | .394 | ** | −.035 | *** | 14.888 | *** | −.020 | .745 | * | .057 | ** | |
SO | 7.539 | *** | .045 | *** | .484 | *** | −.025 | *** | 16.137 | *** | .052 | *** | .566 | * | −.034 | * |
SZ | 7.319 | *** | .053 | *** | .312 | ** | −.022 | ** | 15.479 | *** | .030 | .631 | * | .012 | ||
TG | 7.193 | *** | .053 | *** | .541 | *** | −.025 | ** | 15.877 | *** | .066 | *** | .750 | ** | −.020 | |
TI | 7.041 | *** | .055 | *** | .565 | *** | −.027 | *** | 16.459 | *** | .066 | *** | .555 | ** | −.012 | |
UR | 5.647 | *** | −.003 | .424 | .035 | * | 13.641 | *** | −.076 | *** | −.039 | .072 | *** | |||
VD | 7.900 | *** | .045 | *** | .311 | *** | −.018 | 17.263 | *** | .049 | ** | .282 | .003 | |||
VS | 7.511 | *** | .046 | *** | .120 | −.010 | 16.168 | *** | .055 | ** | .326 | −.022 |