Fee-for-service reimbursement, particularly to small groups of physicians, has been fingered as a major cause of poor health care coordination and excessive spending. Both on the care coordination and reimbursement sides, reforms have been proposed, including medical homes, accountable care organizations and global payments or episode-based reimbursement. The United States is not the only country looking at how to change payment and organization of care; Germany, Switzerland and the Netherlands have also experimented with reform. An article in Health Affairs looks at the Swiss experience. (Health Affairs Article)
The study basically involved giving Swiss physicians and consumers a survey with choices about what it would take for them to accept various attributes of coordinated care versus the fee-for-service system. All Swiss citizens have to have health insurance, which can be fee-for-service or coordinated care and most Swiss physicians practice relatively autonomously and get fee-for-service payments. The survey found that doctors would need to be paid about about 17% more to accept treatment guidelines and 8% more for shared decision-making; they also would need 16% more to leave fee-for-service payment.
Consumers wanted premiums to be reduced 35% to agree to see only doctors who were less expensive and 22% for a two-year wait for coverage for new treatments. Altogether, the physicians and consumers would need a lot of compensation to switch to full coordinated care plans. While the study has potential biases and other issues, the real-life experience of coordinated care plans in Switzerland provides support to the study–coordinated care plans have only a 10% market share. The authors calculate, however, that it is likely that the savings from coordinated care, which have been very substantial, may be enough to provide both the additional payments to physicians and reduced premiums to consumers to generate acceptance.
