A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance funds in Switzerland.
OBJECTIVE
The present investigation focuses on the following questions: 1. Are complementary medical services paid for by a health insurer used in addition to orthodox medical services, or as substitute for them?; 2. If health insurers include complementary medical services in the basic cover, what will be the effect on costs?; 3. If complementary medical services as included in the basic cover, what will be the effect on the policyholders' subjective state of health?


METHODS
A randomized experiment was set up in which 7500 members of Switzerland's biggest health insurance fund, Helvetia, were offered free supplementary insurance for alternative medicine for 3 years. This simulated a situation in which the experimental group had access to the full range of complementary medical treatments under their health insurance policies. The remaining members in the scheme (670,000) people) formed the control group. To evaluate the effect on costs, we analysed the health insurer's cost and benefits data. In addition, a survey was carried out among random samples of subjects from the experimental group and from the control group using the 36-Item Short-Form Health Survey (SF-36) to examine the effects of including complementary medicine on subjective state of health.


RESULTS
The analysis of the cost data shown that subjects used alternative in addition to orthodox medical services. It is also clear that alternative medical treatments are given in combination with orthodox medicine; less than 1% of the experimental group used exclusively alternative medical services. However, as only a very small percentage of experimental subjects (6.6%) took advantage of complementary medicine, no significant impact on overall health costs can be inferred. On the other hand, multiple regressions show that use of complementary medicine has a greater effect on treatment costs than sex, age or language region. Neither at the beginning nor the end of the experiment were any significant differences noted in the scales of the SF-36 between the experimental and the control group. Nor did multiple regressions reveal any effects on subjects' state of health due to the inclusion of complementary medicine in the basic insurance cover.
Sommer
J H
JH
University of Basel, Health Economics and Social Policy Research Unit, Switzerland.
Bürgi
M
M
Theiss
R
R
D000328:Adult; D000368:Aged; D015510:Clinical Medicine / Q000191:economics* / Q000379:methods; D000529:Complementary Therapies / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007342:Insurance Benefits / Q000592:standards; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000592:standards; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012044:Regression Analysis; D013557:Switzerland