Background
Methods
-
Activity as primary care provider in a single-handed or group practice for at least two days per week.
-
Holder of a CAM certificate approved by the Swiss Medical Association (CAM physicians) or no medical activity in CAM (COM physicians).
-
Availability of reimbursement data for 2002 and 2003.
-
No medical activity using exclusively acupuncture.
Data collection, sampling procedures
-
COM physicians: Physicians performing no CAM procedures (conventional primary medical care physicians).
-
Noncertified CAM physicians: Physicians performing CAM and COM procedures without professional certification in CAM and without reimbursement of expenditures for CAM procedures in basic health insurance.
-
Certified CAM physicians: Physicians performing CAM and COM procedures with CAM certificates provisionally recognized by basic health insurance (homeopathy, anthroposophic medicine, neural therapy, traditional Chinese medicine).
Data analysis
-
Consultation related costs, i.e. all costs generated during a consultation (mainly related to the length of consultation)
-
Referral costs (including lab analyses and physiotherapies only)
-
Medication costs, including costs for medication directly dispensed to patients and prescribed medications.
-
The sum of all costs (consultation related, medication, and referral costs).
-
Group: Certified- or noncertified CAM physicians, or COM physicians
-
Canton: Geographic location of practice in Switzerland (26 Cantons)
-
Urbanisation of practice location: central city, suburb, isolated town or village, rural area
-
Type of practice: individual or group practice
-
Gender of physician
-
Experience of physician as years since graduation
-
Proportion of consultations with female patients per year
-
Average age of patients
-
Proportion of home visits per year
-
Proportion of accident related consultations per year
Results
Attributes of patients and consultations
Health insurance expenditures
certified CAM | noncertified CAM | COM | ||||
---|---|---|---|---|---|---|
mean | median | mean | median | mean | median | |
Number of patients per year | 652 | 537 | 955 | 899 | 987 | 906 |
Number of consultations per year | 2797 | 2440 | 3811 | 3726 | 3918 | 3783 |
- Disease related | 2746 | 2421 | 3694 | 3621 | 3822 | 3731 |
- Accident related | 40 | 14 | 100 | 76 | 82 | 46 |
- Other (maternity, unclassified) | 12 | 2 | 17 | 3 | 13 | 2 |
- Number of home visits | 79 | 30 | 268 | 181 | 304 | 211 |
Number of consultations per patient and year | 4.6 | 4.2 | 4.1 | 3.9 | 4.2 | 4.0 |
Type of reimbursement | certified CAM | noncertified CAM | COM | |||
---|---|---|---|---|---|---|
mean | median | mean | median | mean | median | |
Consultation related costs
|
428
|
367
|
319
|
304
|
334
|
315
|
Referral costs
|
67
|
55
|
91
|
77
|
98
|
89
|
- Lab analyses | 31 | 23 | 40 | 27 | 42 | 33 |
- Physiotherapy | 35 | 27 | 51 | 43 | 56 | 53 |
Total costs for medication (directly dispensed & referred) |
198
|
142
|
384
|
351
|
484
|
458
|
- Costs of dispensed medication | 71 | 29 | 159 | 92 | 145 | 46 |
- Prescriptions | 130 | 60 | 226 | 106 | 337 | 278 |
Total costs |
691
|
630
|
794
|
754
|
911
|
878
|
Type of reimbursement | certified CAM | noncertified CAM | COM | ||||||
---|---|---|---|---|---|---|---|---|---|
LS-mean | CI 95 | % | LS-mean | CI 95 | % | LS-mean | CI 95 | % | |
Consultation related costs* | 408a
| 362–455 | 56.2 | 304b
| 258–350 | 40.8 | 278b
| 231–326 | 39.1 |
Referral costs* | 63a
| 47–78 | 8.7 | 82b
| 67–97 | 11.0 | 76ab
| 60–91 | 10.7 |
- Lab analyses* | 25a
| 16–34 | 3.4 | 39b
| 30–47 | 5.2 | 35b
| 26–44 | 4.9 |
- Physiotherapy | 37 | 28–47 | 5.1 | 43 | 33–52 | 5.8 | 40 | 30–50 | 5.6 |
Total costs for medication* (directly dispensed & referred) | 255a
| 213–297 | 35.1 | 362b
| 320–404 | 48.5 | 362b
| 319–405 | 50.9 |
- Costs of dispensed medication* | 96a
| 68–125 | 13.2 | 135b
| 107–163 | 18.1 | 132b
| 103–160 | 18.6 |
- Prescriptions | 161a
| 115–207 | 22.2 | 227b
| 181–272 | 30.4 | 228b
| 181–275 | 32.1 |
Total costs†
|
726
| 661–792 | 100.0 |
746
| 681–811 | 100.0 |
711
| 644–778 | 100.0 |
Factor | Parameter estimates of continous dataa
| |||
---|---|---|---|---|
Consultation related cost | Referral related cost | Total cost for medication | Total costs | |
Experience of physician in years | -0.26 | -0.31 | 1.69* | 1.24 |
Proportion of consultations for female patients | -4.18* | 0.31 | -5.88* | -9.71* |
Average age of patients | 6.48* | 1.86* | 12.72* | 21.24* |
Proportion of home visits | -793.01* | 178.68* | 546.16* | -16.45 |
Proportion of accident consultations | -2718.22* | 13.15 | -581.06 | -3165.41* |
Overall F-tests of categorical variablesb
| ||||
p-value | p-value | p-value | p-value | |
Physicians group | <.001 | 0.011 | <.001 | 0.483 |
Canton | 0.020 | 0.001 | <.001 | <.001 |
Practice location | 0.286 | 0.006 | 0.354 | 0.057 |
Type of practice | 0.025 | 0.881 | 0.492 | 0.065 |
Gender of physician | 0.467 | 0.706 | 0.004 | 0.009 |