[The covering physician system from the viewpoint of the insurance company].
The main question is: To whom and according to which regulations does the nonresident physician bill for reimbursement? The analysis brings to evidence, that different answers have to be given for each kind of treatment (outpatient medicine, care in ambulatory settings of hospitals, and inpatient medicine). Moreover, each kind has to be looked at differently with regard to three categories: (1) the patient who pays himself (self payers scheme), (2) the patient who is subject to the social illness insurance, and (3) the one is subject to the compulsory social accident insurance. The whole matter is extremely complex, and thus little understood as well by the nonresident physician as by the patients. Furthermore, economic disparities are apparent when looking at the various social insurance legislations, and when considering the medical tariff of each social insurance scheme. Obviously, the self payer schemes are simple, transparent and thus better understood: The nonresident physician bills to the patient directly, who in term owes payments, regardless whether he is insured or not. This system applies to all non-social insurance schemes, particularly to the private insurance scheme. Yet, the self payers schemes are successful only when State and local governments reduce their subsidies and grants to their own hospitals, and if all medical services are paid on an effective cost basis: in order to give equal chances to all medical services, private and public. Thus, the patients' position would be uprated. At the same token, the nonresident physicians would have firmer chances which in turn would mean an enormous advantage to their patients since they could be treated by one and the same physician before, during and after their hospital stays.
Richner
C
C
Winterhur-Versicherungen.
D005251:Fees, Medical / Q000331:legislation & jurisprudence; D006777:Hospitals, Proprietary / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D007359:Insurance, Surgical / Q000191:economics*; D008504:Medical Staff Privileges / Q000191:economics*; D008505:Medical Staff, Hospital / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D013557:Switzerland
Das Belegarztsystem aus der Sicht der Versicherer.