[The cost-insurance-spiral in health care]

The working hypothesis is that a cost-insurance spiral is operating in the Swiss health care system. It consists of three causal links. First, insurance coverage is one of the factors influencing the probability with which an individual sees a physician for a given condition. With improved coverage, demand for initial contacts will rise, inducing changes in ambulatory cost per case treated as well as in the propensity of hospitalization. Due to this second relationship, members of the sick funds find themselves exposed to an increased financial risk. Therefore, they tend to adjust coverage accordingly. With this third link, a feedback is established, and the cost-insurance spiral is ready to go into another round. The questions of whether such a spiral exists, the speed with which it turns, and how it could be slowed down are at the core of an investigation that will be completed in 1982. Members of a major sick fund have already been sampled in order to supplement insurance records with socioeconomic data.