A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance funds in Switzerland.

OBJECTIVES: The present investigation focuses on the following questions: 1. Are complementary medical services paid for by a health insurer used in addition to orthodox medical services, or as substitute for them?; 2. If health insurers include complementary medical services in the basic cover, what will be the effect on costs?; 3. If complementary medical services as included in the basic cover, what will be the effect on the policyholders' subjective state of health? STUDY DESIGN: A randomized experiment was set up in which 7500 members of Switzerland's biggest health insurance fund, Helvetia, were offered free supplementary insurance for alternative medicine for 3 years. This simulated a situation in which the experimental group had access to the full range of complementary medical treatments under their health insurance policies. The remaining members in the scheme (670,000) people) formed the control group. To evaluate the effect on costs, we analysed the health insurer's cost and benefits data. In addition, a survey was carried out among random samples of subjects from the experimental group and from the control group using the 36-Item Short-Form Health Survey (SF-36) to examine the effects of including complementary medicine on subjective state of health. RESULTS: The analysis of the cost data shown that subjects used alternative in addition to orthodox medical services. It is also clear that alternative medical treatments are given in combination with orthodox medicine; less than 1% of the experimental group used exclusively alternative medical services. However, as only a very small percentage of experimental subjects (6.6%) took advantage of complementary medicine, no significant impact on overall health costs can be inferred. On the other hand, multiple regressions show that use of complementary medicine has a greater effect on treatment costs than sex, age or language region. Neither at the beginning nor the end of the experiment were any significant differences noted in the scales of the SF-36 between the experimental and the control group. Nor did multiple regressions reveal any effects on subjects' state of health due to the inclusion of complementary medicine in the basic insurance cover.

[Health economic analysis of the effects of including complementary medicine in the benefit package of health insurance]. / Gesundheitsökonomische Analyse der Wirkungen des Angebots komplementärmedizinischer Leistungen der Krankenkassen.

A randomized experiment was set up in which 7,500 policyholders of Switzerland's largest health insurance fund, Helvetia, were offered free supplementary insurance for complementary medicine for 3 years. This was meant to simulate a situation in which the experimental group had access to the full range of complementary medical treatments under their health insurance policies. The remaining policyholders in the scheme (670,000 people) formed the control group. A third group of policyholders who had taken out additional insurance for complementary medical services at their own expense is mentioned only in passing. The health insurer's cost and benefit data were analyzed to evaluate the effect of the offered free supplementary insurance for complementary medicine. In addition, a survey was carried out among random samples of subjects from the experimental group and from the control group using the 36-Item Short-Form Health Survey (SF-36) to examine the effects of including complementary medicine on people's subjective state of health. The analysis of the cost data showed that subjects in the experimental group used complementary medicine in addition to mainstream medical services. It became also clear that alternative medical treatments were given in combination with orthodox medicine; less than 1% of the experimental group used exclusively alternative medical services. However, as only a very small percentage of the experimental subjects (6.6%) took advantage of complementary medicine, no significant impact on overall health cost could be inferred. On the other hand, multiple regressions showed that the use of complementary medicine had a greater effect on the treatment costs than sex, age or language region. Neither at the beginning nor the end of the experiment were any significant differences noted in the scales of the SF-36 between the experimental and the control group; nor did multiple regressions reveal any effects on subjects' state of health due to the inclusion of complementary medicine in the basic insurance cover. This study was presented in the media and at a public hearing of the Swiss National Science Foundation. It triggered numerous valuable discussions. The study design and the conclusions were not left uncontested.

[Health economic analysis of the effects of offered complementary medical procedures on health insurance]. / Gesundheitsökonomische Analyse der Wirkungen des Angebotes komplementärmedizinischer Leistungen der Krankenkassen.

A randomized trial is being conducted to determine whether the offer of unconventional medicine as a health benefit by the health insurance funds has a substitutional or additional effect on the use of conventional medicine. For this purpose, a stratified random sample of 5000 enrollees of the largest Swiss health insurance fund is receiving, as an experiment group, an insurance supplement for unconventional medicine during the next three years free of charge. The rest of the insured population with comparable health insurance but without coverage of unconventional medicine is the control group. The third group to be examined are insured persons who have already chosen the unconventional health insurance supplement on their own account. Data of inpatient and outpatient costs and use of conventional and unconventional health services will be collected and analyzed. The third group with self-selected insurance supplement for unconventional medicine will be compared systematically with the other two groups. A further random sample of persons from each of the three groups will be interviewed at different points of time about their health perceptions.

Fluorescence polarization decay of tyrosine in lima bean trypsin inhibitor.

The fluorescence of lima bean trypsin inhibitor is due to a single tyrosine residue at position 69. The lifetime of this tyrosine fluorescence is 620 +/- 50 ps (mean +/- SD) and is little affected by addition of 0.88 M citrate, an efficient quencher of tyrosine fluorescence. The steady-state emission intensity is also only weakly reduced by the quencher. The tyrosine is thus not accessible to the citrate and is probably located in the interior of the protein. The high pK of the tyrosine supports this conclusion. The fluorescence anisotropy decay of the inhibitor's tyrosine can be fitted to a double exponential form, with time constants of about 40 ps and greater than or equal to 3 ns. The anisotropy at time zero is 0.19 +/- 0.015 (mean +/- SD), the same as for N-acetyl-L-tyrosinamide in viscous glycerol solution. The nanosecond component of the decay is consistent with rotation of the entire protein molecule. The 40-ps component demonstrates that the tyrosine has considerable freedom to move independently of the protein as a whole. This rotational correlation time is approximately what is observed for free tyrosine in aqueous solution. Since the polypeptide chain near tyrosine-69 is anchored by several disulfide bonds, the data argue that this interior portion of the protein consists of a rigid, immobile backbone embedded in fluid, mobile amino acid side chains.