Comparison of Swiss basic health insurance costs of complementary and conventional medicine.

BACKGROUND: From 1999 to 2005, 5 methods of complementary and alternative medicine (CAM) applied by physicians were provisionally included into mandatory Swiss basic health insurance. Between 2012 and 2017, this will be the case again. Within this process, an evaluation of cost-effectiveness is required. The goal of this study is to compare practice costs of physicians applying CAM with those of physicians applying solely conventional medicine (COM). METHODS: The study was designed as a cross-sectional investigation of claims data of mandatory health insurance. For the years 2002 and 2003, practice costs of 562 primary care physicians with and without a certificate for CAM were analyzed and compared with patient-reported outcomes. Linear models were used to obtain estimates of practice costs controlling for different patient populations and structural characteristics of practices across CAM and COM. RESULTS: Statistical procedures show similar total practice costs for CAM and COM, with the exception of homeopathy with 15.4% lower costs than COM. Furthermore, there were significant differences between CAM and COM in cost structure especially for the ratio between costs for consultations and costs for medication at the expense of basic health insurance. Patients reported better quality of the patient-physician relationship and fewer adverse side effects in CAM; higher cost-effectiveness for CAM can be deduced from this perspective. CONCLUSION: This study uses a health system perspective and demonstrates at least equal or better cost-effectiveness of CAM in the setting of Swiss ambulatory care. CAM can therefore be seen as a valid complement to COM within Swiss health care.

Development of costs for complementary medicine after provisional inclusion into the Swiss basic health insurance.

BACKGROUND: In 1999, 5 complementary procedures were included into the Swiss basic health insurance on a provisional basis. In consequence, many people expected a substantial increase of costs of up to CHF 110 million or even higher. METHODS: Data on consultation costs at the expense of basic health insurance for the period of 1997-2003 were analyzed for 206 certified complementary and alternative medicine (CAM) physicians with 1 or multiple certificates for complementary medicine. The data was provided by the Swiss health insurers' data pool (santésuisse). The 2 major Swiss health insurers provided additional cost data of expenditures reimbursed by private health insurance for complementary medicine. This allowed a longitudinal analysis of consultation costs at the expense of basic health insurance and the costs of private health insurance of certified CAM physicians. Furthermore, those costs were compared to the respective costs of 119 non-certified CAM physicians and 145 physicians in conventional practices. RESULTS: The development of consultation costs of certified CAM physicians at the expense of basic health insurance showed a net annual increase of CHF 54,200 per physician between 1998 and 2002 and of CHF 35.9 million for all 663 certified CAM physicians. On the other hand, costs at the expense of private health insurance for complementary medicine decreased in the same period by CHF 34,300 per certified CAM physician and by CHF 22.8 million for all 663 certified CAM physicians. CONCLUSION: The inclusion of 5 complementary disciplines into the Swiss basic health insurance led to an increase of costs, which was, however, much lower than predicted.