Scientific publications

Der Patient im Managed-Care-Modell oder der Arzt als Teil eines Ärztenetzes: Was führt zum Effizienzgewinn? (Peer Review)


Oliver Reich, Roland Rapold, und Eva Blozik

Abstract: Aim: To evaluate the role of physician-related as compared to patient-related factors, we compared the efficiency effect of a patient being enrolled in an MC health plan versus the general practitioner (GP) being part of a physician network. Methods: Secondary analysis of claims data of the Swiss basic health insurance. Multivariate linear regression was performed to investigate the association between efficiency effect and enrolment in a MC health plan and/or participation of the GP in a physician network.

Results: MC enrollees managed by network physicians had the expected result of −13 %. Management of non-MC enrollees by the same physicians was less efficient (−2 %). Patient-sided gatekeeping without network physicians lead to efficiency effects of −10 %.

Conclusion: Obviously, management by network physicians differs according to the health plan of their patients.

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