“With the unified fund there would be an administrative juggernaut”

How do you classify the “premium shock”?
Stephen Wirz: The premium increase of 6.6 percent is an average. Depending on the region and health insurer, this can affect customers to a greater or lesser extent. This was necessary, because the premiums have increased only slightly under political pressure in the past two years. In addition, health insurers generated less income or in some cases even losses on the capital markets. Further increases will therefore take place in the coming years. The current rise is more on the lower side of what is needed.

What is your advice to premium payers?
You can and should optimize within health insurance. This includes both alternative insurance models and an adjustment of the franchise. There are also attractive new models. Until now, the general practitioner, telephone or pharmacy model is known. Now there are mixed solutions, for example from Sanitas (Medbase MultiAccess) and Groupe Mutuel (PrimaFlex), whereby customers can choose the first point of contact (doctor, TelMed or pharmacy) on a case-by-case basis. And you should also look closely at the insurance itself, because there are large differences in premiums between the individual providers. The basic insurance and the supplementary insurance do not have to be in the same place.

With the deductible there is the risk that you opt for an excess that you cannot pay in case of an emergency. This can have serious consequences for the insured.
The problem is not that big. Most people are insured against accidents by their employer. The franchise doesn’t matter. There is also no deductible for maternity. End-of-life hospitalization insurance is an option for risks associated with illness. Depending on the amount of capital, it costs about 20 francs per month and a fee is paid in case of hospitalization. By increasing the deductible from CHF 300 to CHF 2,500, you will save approximately CHF 125 per month. The bottom line is that this still saves more than 100 francs a month with better protection in the event of a hospital accident. Then it is often said that you can no longer check with a high deductible. However, it is often included in the supplementary insurance policies without deductible. And for the new year, Groupe Mutuel offers a model with the PrimaFlex that exempts generics from the franchise.

You need to know that first.
People use the Premium calculators from Comparis or Priminfo to find the cheapest offer. However, you do not see which restrictions the model contains. That is why it is important to seek advice from someone who has an overview. Our company has 160,000 customers. We look for individual solutions with those dealing with an above-average increase.

What leeway do health insurers have?
The scope is very limited. Health insurers already have relatively very low administrative burdens. In some cases, calls are made to remove the contractual obligation with doctors, so that they no longer have to pay those who cause above-average costs. Attempts are also being made to no longer accept individual benefits from the basic insurance, because the effectiveness has not been proven. At the same time, insurers are trying to strengthen customer loyalty. This year it is happening more intensively than ever before. You want to prevent customers from migrating by proposing alternatives. It is a game against time for the customer and the insurer, because November 30th is quickly over.

What can politics do?
Solutions are especially needed to lower the premium. It is always said that the premium is unfair. That’s true in principle, but there are discounts for low incomes. The main problem is that they are not exhausted. Depending on the canton, you sometimes have to make an active effort. That’s a big problem. It should be uncomplicated. The declaration can be used to determine who is entitled to a premium discount.

There are discussions in politics about a cost brake. Do you see an opportunity there?
Of course you can make selective concessions in the service catalog. But you need to get to the root of the problem and stop sending people to the doctor for trifles. It starts with the doctor’s certificate that you must submit to your employer after you have been absent for more than three days. Without this requirement, there would be fewer doctor visits. You can also get a doctor’s certificate by telephone. I am also a proponent of flexible models. After a tick bite or sunburn you can be treated in the pharmacy and you do not have to go to the doctor. In the case of trifles, a phone call to the primary care center is often enough to avoid a time-consuming, often unnecessary and expensive trip to the emergency room.

However, in the current system, those who provide as many services as possible benefit.
That’s a problem, but there’s room to manoeuvre. In politics there are two approaches for me: optimizing premium discounts and managed care, or integrated care. Managed care models should become the standard.

What do you think of the phone brokers that piss off a lot of people?
Fortunately, there are independent intermediaries, because they give customers the opportunity to become acquainted with innovative insurance models and products and differences in premiums. Cold calling over the phone is annoying though. However, the problem has diminished as cold calling is no longer allowed in the health insurance field, and this is also monitored by the health insurers. Unfortunately, there are still a few black sheep, but the advertising activities of health insurers and brokers have shifted to the Internet and sales stands in shopping centers for example. You have to get new customers somehow.

It is said that health insurers need about ten percent of new customers annually to replace those lost through death or termination.
It is the goal of every health insurer to compensate for the departures, especially if a health insurance fund has to raise the premiums above average. Then the customers walk away. So the same insurer has to increase the promotional activity to find new customers.

How do you rate an investment fund?
I understand the request, but there would be an administrative juggernaut. And which insurance becomes a unified health insurance fund? Presumably the one with the largest market share in a canton. This can lead to a health insurer becoming a single fund in a canton where another health insurer is established. This would be nonsensical. I prefer other measures: managed care, mandatory generic drugs, targeted premium reductions to alleviate lower incomes. But there is no ideal solution. It requires the sum of many small measures.