No more special cases in Switzerland: These are the five best suggestions for lower health insurance premiums

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Now the cat is out of the bag – as expected, the premium is attractive: Minister of Health Berset (51) announced at the press conference he held today, Tuesday, that health insurance premiums will increase by 8.7 percent on average next year. This is the largest increase since 2010; Last year’s premiums increased by an average of 6.6 percent.

The main reason for the increase in premiums is outpatient care, which is reasonable but expensive for health insurance companies. More and more procedures no longer need to be done in a hospital, but can be performed without overnight stays or supervision. This saves costs in the system. But this is not the case with health insurance companies: They pay 100 percent of outpatient procedures, while the cantons help finance hospital treatment.

So how can major premium increases be avoided in the future? What ideas are there to reduce health care costs?

Certainly not by eliminating the basic insurance requirement, perhaps as a calculated violation of a taboo, as Zurich SVP health director Natalie Rickli recently put in place. So how then?

Effective recipes have been on the table for a long time

In fact, effective recipes have been on the table for a long time. Soon after the vote on the health insurance law in 1994, it became clear that “major reform would be needed again soon,” recalls expert Monika Merki Frey from the healthcare consultancy Merkihealth. But nothing happened. “Out of fear, decision-makers at the time were not ready to seriously plan and implement reforms to control costs,” says Merki. “And it’s exactly the same today.” This is very frustrating.

Health economist Heinz Locher echoes the same sentiment. «A very important point, namely compliance with existing legal provisions, is not discussed. “Legislation is binding!” Locher speaks of a “tragedy”. If the approximately 800 employees of the Federal Public Health Agency do not fulfill their main duties or do not perform it sufficiently consistently, one can also speak of state failure.

Health system is an element of location quality

However, it should be noted in advance that Switzerland has a very high-quality healthcare system. “Maintaining the security of supply and the quality of the resulting position must be at the forefront of political activities,” analyzes Katja Berlinger, president of the Swiss Medi Kids pediatricians chain and board member of the Insel hospital group. The practitioner says: “Healthcare is not too expensive for a rich country like Switzerland, accounting for 12 percent of GDP. The real problem lies not in rising costs but in the lack of transparency and flaws in the current system. »

So: What reforms are needed? Here are five ideas:

1. End of special status for medicines in Switzerland

The cost of medicines in basic insurance is around 8 billion francs, almost as important as outpatient services; In fact, it should be noted that it is even more important than inpatient treatment. However, Switzerland has its own complex approval system and national regulations. This increases costs. Katja Berlinger from Swiss Medi Kids therefore demands: “We must simplify the approval of medicines in Switzerland. In particular, we must accept or recognize foreign approvals from regions with similar drug control; the EU is particularly important. Including pricing regulations.”

Berlinger also believes it makes sense to recalculate the current pricing system for lifetime drug treatments to reduce costs.

Consultant Monika Merki Frey adds: “There finally needs to be transparency in drug prices. “The pricing system needs to be regulated in the Health Insurance Law.” Merki Frey said Switzerland’s “taboo” on price setting should be broken.

More importantly, innovations such as new antibiotics or new cancer treatments can and should be valuable to the pharmaceutical industry. The prices of the majority of so-called fake innovations that burden healthcare budgets need to be significantly reduced.

2. Cantons should be stripped of their powers in the hospital sector

Jérôme Cosandey of Avenir Suisse sums it up succinctly: “Cantonal hospital lists should be abolished and replaced with nationally valid quality criteria.” All hospitals that meet these national criteria are allowed to bill the insurance company and the canton in which the patient resides, while other hospitals are not. Cosandey believes this will allow clinics to specialize. “And expensive, unnecessary structures are being reduced.”

Expert Merki Frey has something similar in mind. “The public sector must muster the political will not to financially support uneconomic stagnant institutions, regardless of the reaction of the population.” This is not primarily about closing hospitals. But it’s about reuse, collaboration and specialization. In the canton of Solothurn the Breitenbach hospital became a dementia centre, and in the canton of Aargau the Brugg hospital became a medical centre, including outpatient surgery.

In general, according to Merki Frey, the cantons, which often own, operate and also provide services to the hospital sector, are full of conflicts of interest and are therefore sensitive. “Hospitals and clinics should be separated from the public sector. “It needs to be managed within the framework of private law and according to economic criteria.”

3. Forced mergers of inefficient health insurance companies

Ever since UBS swallowed Credit Suisse, we’ve known that poorly managed, inefficient banks could be forced into state takeover. The state needs to take a similar approach to health insurance companies. According to health entrepreneur Katja Berlinger, in the mandatory field these include “federal enforcement bodies such as disability insurance, AHV compensation funds or unemployment insurances”.

But they still face a long leash: “Hospitals only receive comparatively cost-effective tariffs. Health insurance companies, on the other hand, may engage in uneconomic behavior. The premium payer always has to pay high administrative costs.” Berlinger calls for this to be changed: “Health insurers whose administrative costs are excessively high by comparison should be warned. If they can’t reduce costs, they will have to merge with health insurers with lower administrative costs.

Berlinger also added that the personal connection between politics and the cash register should be broken. “Members of the National Assembly are no longer allowed to sit on the bodies of health insurance companies, as is the case with other federal companies such as Ruag, Post or Swisscom.”

4. Prevention credit instead of full coverage

The more expensive the premiums, the greater the incentive for the insured to seek compensation in the form of medical services for the money spent. This vicious circle needs to be broken. “Investments in prevention should be worthwhile,” says Berlinger. “And there is a need for better health education.” This is not about expensive campaigns organized by BAG. But it’s about individual, self-responsible commitment. Berlinger could imagine that anyone with basic insurance would be entitled to a determined amount of lifetime protection benefits.

However, consultant Merki Frey also holds the insured responsible. Just like doctors, physiotherapists and other freely available service providers, they will need to be forced to use digital data processing. “Volunteering needs to be eliminated,” says Merki Frey. Efficiency and quality can only be increased and measured with reasonable effort if no one can avoid electronic patient records anymore.

5. Implement rather than constantly reform

Entrepreneur Berlinger asks, “How can I prevent a law from being enforced?” he asks. The answer: “By changing it over and over again.” It demands that the “pathological reformitis” be finally stopped. In fact, we need to finally ensure “consistent application” of the health insurance law. This is especially true for economic efficiency tests of treatments and quality requirements for service providers.

The issue of legality is also a priority for health economist Heinz Locher. “Laws must be followed and violations punished,” he demands. Only consistent application of existing legal rules will mean that some medical nonsense can no longer be billed through basic insurance. This may reduce the increase in premiums in the future.

Constant staff turnover problem

Do such ideas have a chance of being implemented in practice? Probably not, Merki is afraid of Frey. “A new parliament with new members will be elected this year. Health commissions will also be changed. And when everyone is united, half of the legislative term will be over. And the election campaign begins again.”

The same goes for the new minister who will replace Alain Berset. “He has no chance to make a difference as the new pope. Because in the end, the Curia, the Parliament, decides. And the Curia failed.”

Source :Blick