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How does regulating doctors' admissions affect health expenditures? Evidence from Switzerland
Michel Fuino1, Philipp Trein2, Joël Wagner1,3
1Department of Actuarial Science, University of Lausanne, Chamberonne - Extranef, Lausanne, 1015, Switzerland.
Insights
Switzerland
Area of Science:
- Health policy research
- Healthcare economics
- Public health regulation
Background:
- Cost containment is a critical global health policy challenge.
- Switzerland has implemented moratoriums on physician admissions to control costs.
- These regulations target both specialist and general practitioner (GP) numbers.
Purpose of the Study:
- To evaluate the impact of Swiss moratoriums on physician supply and healthcare costs.
- To analyze the effects of national and cantonal-level regulations.
- To inform health policy decisions regarding cost containment strategies.
Main Methods:
- Analysis of Swiss health insurer data (SASIS) from 2007-2018.
- Utilized interrupted time series and difference-in-differences models.
- Examined physician billing numbers and direct medical costs.
Main Results:
- Lifting the national moratorium in 2012 increased physician numbers without significantly raising costs.
- Reintroducing cantonal moratoriums in 2013-2014 reduced physician numbers.
- Cantonal regulations also did not significantly impact direct health costs.
Conclusions:
- Physician admission moratoriums do not appear to be an effective tool for directly controlling healthcare expenditure growth.
- Healthcare supply regulation via moratoriums has a limited impact on overall health costs.
- Policy interventions need to consider broader factors influencing health spending.
Background:
Cost containment is a major issue for health policy, in many countries. Policymakers have used various measures to deal with this problem. In Switzerland, the national parliament and subnational (cantonal) governments have used moratoriums to limit the admission of specialist doctors and general practitioners.
Methods:
We analyze the impact of these regulations on the number of doctors billing in free practice and on the health costs created by medical practice based on records from the data pool of Swiss health insurers (SASIS) from 2007 to 2018 using interrupted time series and difference-in-differences models.
Results:
We demonstrate that the removal of the national moratorium in 2012 increased the number of doctors, but did not augment significantly the direct health costs produced by independent doctors. Furthermore, the reintroduction of regulations at the cantonal level in 2013 and 2014 decreased the number of doctors billing in free practice but, again, did not affect direct health costs.
Conclusions:
Our findings suggest that regulating healthcare supply through a moratorium on doctors' admissions does not directly contribute to limiting the increase in health expenditures.
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