Less fee-for-services, more flat reimbursement: Does it work in the out-patient sector?

Fee-for services reimbursement incentivizes physicians to diagnose and treat more – and more expensively – than is necessary. The study investigates how changes to the way doctors are reimbursed affect services in the out-patient setting and health care costs.

Traditionally, physicians are reimbursed fee-for-services. This can lead to the provision of more – and more expensive – services than necessary. By comparison, alternative reimbursement schemes, involving flat rates per patient or for complex treatments provide a financial incentive to avoid overtreatment. This is the background against which the reimbursement schemes for primary care physicians and paediatricians were reformed in Switzerland and Germany.

The aim of the study is to investigate how the reforms of the reimbursement schemes remuneration systems in Switzerland and Baden-Württemberg are affecting medical out-patient services and health care costs.

The purpose of reforming the Swiss system is to create financial incentives for moving provision of care away from specialists to primary care physicians. This study will undertake a quasi-experiment that will use routine data to compare the services provided before and after implementation of the reform of the traditional remuneration system. Paediatricians in Baden-Württemberg have the option of choosing between two different reimbursement schemes. They differ with regard to the services for which a flat rate is paid. Routine data will be used to examine how the alternative schemes affect the provision of services. And finally, the results obtained for Switzerland and Baden-Württemberg will be compared.

The study will provide information on how future reimbursement schemes can be designed to avoid overtreatment and curb rising healthcare costs more effectively.