Impact of alternative healthcare plans on out-of-hours help-seeking intentions in Switzerland

Abstract

INTRODUCTION: In Switzerland, mandatory health insurance plans (standard) offer free access to secondary and emergency care. However, in return for a lower premium, individuals can choose alternative healthcare plans (HCPs), with either a general practitioner (GP) or a medical call centre (Telmed) acting as gatekeeper. AIM: To examine the impact of alternative HCPs on patients' intended help-seeking behaviour out-of-hours (OOH) in Switzerland. METHODS: A secondary analysis of the Swiss data collected for the EurOOHnet survey on help-seeking behaviour in Denmark, the Netherlands and Switzerland was made. The survey used hypothetical scenarios for measuring two outcome measures: Intended help-seeking for (1) OOH care and (2) OOH face-to-face care. Binomial regression analyses were used to test the influence of HCPs on intended OOH help-seeking, adjusted for other (population) characteristics. RESULTS: Telmed-insured persons were more inclined to OOH help-seeking than persons with a standard HCP (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.91-2.72; controlled for other population factors), mainly driven by contact with the medical call centre (31 vs 5%), and were less inclined to have an OOH face-to-face contact (OR 0.69, 95% CI 0.55-0.87). Persons with a GP HCP had a lower intended use of face-to-face OOH care contacts than persons with a standard plan (OR 0.74, 95% CI 0.63-0.86). CONCLUSION: Alternative HCPs on a voluntary basis seem to influence the use of OOH care. These results could be relevant for policy makers, especially from nongatekeeping countries, to reduce irrelevant use and subsequent costs of emergency and OOH care services.