title: [Social change in the physician's role and medical practice caused by managed care in Switzerland].
abstract: Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.
authors.affiliation: Abt. Evaluation und Med. Informatik AEI, Psychiatrische Universitätsklinik Zürich. pcme@bli.unizh.ch
authors.forename: P C
authors.initials: PC
authors.lastname: Meyer
authors.forename: M D
authors.initials: MD
authors.lastname: Denz
mesh_terms: D003363:Cost Control / Q000639:trends; D005544:Forecasting; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000639:trends*; D009313:National Health Programs / Q000191:economics / Q000639:trends*; D010819:Physician's Role; D012922:Social Change; D013557:Switzerland