Three essays on supply and demand in the Swiss health care system

The Swiss health care system is facing various challenges including high health care costs, wasteful and medically harmful over-treatment, regional variation in access to care and a lack of transparency. Because physicians and patients are granted considerable autonomy in medical decision making a thorough understanding of their motives and behaviors is a prerequisite for successful policy. This doctoral thesis investigates physicians' preferences for financial profit, the role of patients' levels of information, the effects of prospective payment systems on the provision of care and the effects of public health promotion programs on the demand for preventive care. The first empirical study shows that physicians react to changes in marginal revenue per unit of care which confirms the hypothesis that they have preferences for financial profit. This result implies that physicians provide more care when they are paid retrospectively and that prospective payment systems can be effective measures against over-provision of care. The second study investigates the effects of consumer information on the outcome of the physician - patient interaction in outpatient care to identify physician induced demand. The analysis does not show any significant effect of consumer information on the number of outpatient physician visits and thus does not confirm the hypothesis that physicians induce more demand in their less-informed patients. The third study shows that organized screening programs providing health information and free access to mammography have only a modest effect on the demand for mammography when utilization is already high. The empirical results of this thesis suggest that the provision of consumer information or organized screening programs are potentially ineffective policy instruments and that prospective payment systems can be used more widely to control the provision and the costs of medical care in Switzerland.

Thèse de doctorat : Université de Neuchâtel, 2015 ; 2516