[Country-specific differences in the utilisation profiles of cross-border health care point to differentiated degrees of interest and selective use. Results of a German-Swiss pilot project]

Abstract

Aim: The pilot project Lörrach-Basel was implemented in 2007 to reduce the border effect in respect to the health care services for the citizens of the region. The study deals with the questions as to which patient groups utilise cross-border health care, with special regard to the accompanying financial streams, and what implications these utilisation profiles will have for the development of a health region.

Methods: Applications for cost assumption and hospital routine data concerning cross-border care, data of legal health insurance schemes of both participating countries for the financing of border crossers' medical care, in addition, question-related contents from expert interviews with hospitals or rehabilitation facilities in both countries and a random sample from routine hospital data of treatments in Switzerland under complementary private insurance terms were analysed.

Results: Regarding the actual use of the pilot project by Swiss insured persons in the second project year, an exclusive utilisation appeared in the area of rehabilitation with a total of 125 cases. 73% of all treatments took place in two rehabilitation centres. Only 8 cases from the German side corresponded to the framework of the pilot project and concerned - according to contract - highly specialised in-patient care. The applications for cost assumption addressed to German legal health insurance schemes aimed at a wide spectrum which went beyond the offer within the pilot project's framework. Only one-half of the top 10 locations by number of applications are a partner in the pilot project. When looking at the whole transnational patient mobility in the border region of Basel-Lörrach, including the cases financed by complementary insurances and schemes for border crossers, but with the exception of private insured persons, a nearly well-balanced mutual use of the medical offers (scale: by 4 million Euros) is found concerning the costs. Persons insured in Basel consume more medical care within the scope of the compulsory health insurance in Lörrach than persons, insured in Lörrach, consumed in Basel; the reverse trend appears for treatment cases financed by complementary insurances.

Conclusions: The differences concerning age groups, contents and kinds of treatment point in the direction of a search for complementary potentials with the aim of adapting the cross-border health care offers to the future needs of the region.