Patientenwanderungen in der EU: Modellierung und Implikationen für die Schweiz

In the EU the organization and financing of health care belong to the domain of authority of national governments. The program El 12 is an exception to this rule, permitting EU citizens to apply for medical treatment in another EU country, to be paid for by domestic social security. In spite of its uniform legal basis, the program has been used to a quite different extent by citizens in the different EU countries. It appears that by implementing a sufficiently roundabout admission procedure, several countries were able to minimize the number of applications and to pass almost all of them, while other countries had to reject a significant number of them. These differences in program utilization may be explained by modeling the dual principal-agent-relationship characterizing those advisory physicians who review the applications. As a consequence of the new Law on health insurance of 1994 and the growing importance of "managed care" options, Swiss physicians are expected to increasingly become double agents as well. In this paper, it is argued that they will not be able to exclusively cater to patient interests anymore when considering hospitalization outside the Canton of residence but will have to balance patient interests against those of the cantonal government and the sick fund. However, patient interests could be safeguarded by doing away with price discrimination to the detriment of patients admitted from other Cantons in the Swiss hospital sector.