These false incentives are responsible for the cost explosion.

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If costs continue to improve as they have since the start of the year, health insurance premiums could rise by 7.5 percent again this fall. “If we do nothing, we’re going to hit the health system against a wall,” Santésuisse Director Verena Nold (60) warned on the Sunday Blick.

This worries Blick readers: More than 90 percent in one survey said they were worried about the development of premiums.

Some of the cost explosion in healthcare is desirable: we live longer, we die less from cancer, the child mortality rate is historically low. “We’re willing to spend money on that,” emphasizes health economist Tobias Müller, 36, who studies and teaches rising health costs at the University of Applied Sciences in Bern.

On the other hand, the other part of the cost increase is also undesirable. “It stems from misguided incentives, lack of transparency and sometimes exorbitant prices,” says Müller. Blick shows you where the weak spots in the system are and how they can be fixed.

Doctors or hospitals can bill health insurance companies for any additional services in the field of outpatient care. “You don’t need to be surprised if unnecessary services are provided,” Müller criticizes. This starts with unnecessary vitamin D testing and extends to surgical interventions that are not medically necessary for the patient.

Also, interventions that have long been considered obsolete abroad are sometimes reimbursed in Switzerland. “There’s been evidence for 20 years that knee arthroscopy is no better than sham surgery for arthritis,” says Müller. A small camera is inserted into the joint through small incisions to examine the cartilage and meniscus and to remove loose pieces of cartilage. Knee arthroscopy is one of the most common surgical procedures in Switzerland. “The intervention was carried out because it was still paid for,” Müller says. He proposes to “examine” the catalog of paid services.

Health economist Müller criticizes that private patients are extremely lucrative for hospitals and affiliated doctors. “They are given a new hip or knee joint, but may not be medically necessary for another ten years.” Private patients pay extra for their private insurance. However, basic benefits such as a new hip or knee joint are still billed through compulsory health insurance and thus distributed to all premium payers.

In Switzerland, not only pharmacies, but also doctor’s offices distribute medicines. Doctors earn a certain percentage of the money. As a result, they prescribe not only more, but above all more expensive drugs. Only 22 percent of all drugs sold in Switzerland are generic, compared to 83 percent in Germany.

The health insurance association Santésuisse assumes the potential for savings of 200 million francs per year, or 18 percent if generics are continually used instead of the originals. But: Pharmaceutical prices aren’t really the big levers in healthcare costs. According to the pharmaceutical industry, they are only responsible for 12 percent of all healthcare costs.

Not everyone looking for a new general practice has a chance to find which practice works particularly well – they are first-come, first-served. Also, physicians are not obligated to register any diagnosis for outpatient treatment. Therefore, it is not possible for insurance companies to evaluate whether too much or too little service is provided. “We are a developing country compared to other countries,” says Müller. Elsewhere, there are national databases showing which service providers are working particularly efficiently. This increases competition.

In Switzerland, the prices of patent-protected drugs are reviewed every three years by the Federal Office of Public Health (BAG) and renegotiated if necessary. This is not the case with other services of the health system. “We pay about 17 francs for the blood count. Less than 1 euro in Germany », Müller calculates. Some of the tariffs have not been renegotiated for decades. But: False incentives in the system contribute significantly more to high Swiss healthcare costs than higher prices.

Source :Blick