Understanding recent trends in Swiss ambulatory care utilization when out-of-pocket payment is minimal

To examine trends in ambulatory care utilization when individuals face almost no financial barriers to health care.

Observational study of insurance data. Adults with minimal deductible were included. Ambulatory care visits and costs were measured from 1997 to 2002.

Mean ambulatory care costs/insuree increased from 1292.- to 1790.- CHF, corresponding to higher increases in drug costs (+61.7 %) than services costs (+24.3 %). The proportion of visits to generalists decreased while those to hospital outpatient services increased.

In a demographically stable population of insurees, increases in ambulatory care costs were due neither to growth in physicians' visits nor to increasing physicians' fees per act, but to what was included in or prescribed during the visits.