title: Does a mandatory telemedicine call prior to visiting a physician reduce costs or simply attract good risks?
abstract: This paper aims to estimate empirically the efficiency of a Swiss telemedicine service introduced in 2003. We used claims' data gathered by a major Swiss health insurer, over a period of 6 years and involving 160 000 insured adults. In Switzerland, health insurance is mandatory, but everyone has the option of choosing between a managed care plan and a fee-for-service plan. This paper focuses on a conventional fee-for-service plan including a mandatory access to a telemedicine service; the insured are obliged to phone this medical call centre before visiting a physician. This type of plan generates much lower average health expenditures than a conventional insurance plan. Reasons for this may include selection, incentive effects or efficiency. In our sample, about 90% of the difference in health expenditure can be explained by selection and incentive effects. The remaining 10% of savings due to the efficiency of the telemedicine service amount to about SFr 150 per year per insured, of which approximately 60% is saved by the insurer and 40% by the insured. Although the efficiency effect is greater than the cost of the plan, the big winners are the insured who not only save monetary and non-monetary costs but also benefit from reduced premiums.
authors.affiliation: IEMS, University of Lausanne, Lausanne-Dorigny, Switzerland. chantal.grandchamp@bluewin.ch
authors.forename: Chantal
authors.initials: C
authors.lastname: Grandchamp
authors.forename: Lucien
authors.initials: L
authors.lastname: Gardiol
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003363:Cost Control / Q000379:methods; D018588:Fee-for-Service Plans; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D008297:Male; D037141:Mandatory Programs / Q000191:economics*; D008875:Middle Aged; D010820:Physicians; D040242:Risk Reduction Behavior; D013557:Switzerland; D017216:Telemedicine / Q000706:statistics & numerical data*