There are effective recipes on the table: these 5 ideas help against the premium shock

The main reason for the rising premiums is the sensible but expensive outpatient treatment of health insurers. More and more procedures no longer need to be performed in the hospital, but can be performed without overnight stays and monitoring. This saves costs in the system. But not with the insurance companies: they pay 100 percent for outpatient procedures, while the cantons help fund hospital treatment.

But how can huge premium increases be avoided in the future? What ideas are there to reduce healthcare costs?

Certainly not by abolishing compulsory basic health insurance, as recently introduced by the Zurich SVP health director Natalie Rickli (44) – probably as a calculated taboo breakthrough. But how?

30 years behind on reforms

Actually, the effective recipes have been on the table for a long time. Expert Monika Merki Frey of Merkihealth, a healthcare consultancy, recalls that shortly after the 1994 vote on the health insurance bill, it became clear “that another major reform would soon be needed.”

But nothing happened. “At the time, decision-makers were unwilling to seriously plan and implement cost control reforms out of fear,” says Merki. “And today it’s exactly the same.” It’s frustrating.

Health economist Heinz Locher agrees. “One crucial point, namely compliance with existing legal provisions, is not being addressed. Yet the legislation is binding!” Locher speaks of a ‘tragedy play’. If the approximately 800 employees of the Federal Office of Public Health do not perform their core task or do not perform it consistently enough, one could also speak of a state failure.

issue of location quality

However, it should also be noted in advance that Switzerland has a high-quality healthcare system. “Maintaining security of supply and the resulting quality of the location should be the focus of political activities,” analyzes Katja Berlinger, head of the pediatrician chain Swiss Medi Kids and board member of the Insel hospital group. The doctor states: “The healthcare system is not too expensive for a prosperous country like Switzerland with 12 percent of GDP. The real problems are not rising costs, but the lack of transparency and the shortcomings of the current system.”

What reforms are needed then? Here are five ideas:

At over CHF 8 billion, the cost of basic insurance medicines is almost as important as outpatient medical services – and especially more important than inpatient hospital stays. Nevertheless, Switzerland has its own complex approval system and national regulations. That drives up costs. Katja Berlinger from Swiss Medi Kids therefore demands: “We must simplify the approval of medicines in Switzerland. In particular, we should accept or recognize foreign approvals from areas with similar drug controls – the EU should be considered first. Including the compensation scheme.”

In addition, Berlinger believes it makes sense to recalculate the existing pricing system for lifelong drug therapies to reduce costs.

Advisor Monika Merki Frey adds: “There must finally be transparency in drug prices. The pricing system must be laid down in the Health Insurance Act.” The Swiss ‘taboo’ on price fixing must fall, according to Merki Frey.

The most important thing here is that innovations such as new antibiotics or new cancer treatments must and can be worthwhile for the pharmaceutical industry. Prices for most so-called false innovations, which are a burden on healthcare budgets, need to be significantly reduced.

Jérôme Cosandey of Avenir Suisse puts it in a nutshell: “The cantonal hospital lists must be abolished and replaced by nationally applicable quality criteria.” All hospitals that meet these national criteria are allowed to invoice the patient’s insurance company and the patient’s canton of residence, while the others do not. This would cause the clinics to specialize, Cosandey is convinced. “And expensive, redundant structures are reduced.”

The expert Merki Frey has something similar in mind. “Regardless of popular reactions, the public sector must muster the political will to stop providing financial support to uneconomically stationary institutions.” It is not primarily about closing hospitals. But about conversion, cooperation and specialization. For example, in the canton of Solothurn, the Breitenbach Hospital has become a dementia center, and in the canton of Aargau, the Brugg Hospital has become a medical center, including for outpatient surgery.

In general, according to Merki Frey, the cantons, which often simultaneously own, operate and service the hospital sector, are full of conflicts of interest and therefore difficult. “Hospitals and clinics must be separated from the public sector. They must be managed on the basis of private law and economic criteria.”

Since UBS swallowed up Credit Suisse, we know that the state can force badly run, inefficient banks to take over. The state should do the same with health insurance companies. According to healthcare entrepreneur Katja Berlinger, these are in the mandatory field of “federal implementing bodies such as disability insurance, the AHV compensation funds or unemployment insurers”.

And yet they would be left on the long side: “Hospitals only receive rates that are benchmarked to be economical. Health insurers, on the other hand, can act uneconomically. The premium payer always has to pay the high administrative costs.” Berlinger demands that this change: “Health insurers who, according to benchmarking, have too high an administrative burden, must be warned. If they can’t reduce costs, they should merge with health insurers that have lower administrative burdens.”

In addition, according to Berlinger, the personal interdependence between politics and cash registers must be loosened. “National councilors 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.”

The more expensive the premiums, the greater the incentive for policyholders to request medical services in exchange for the money they spend. This vicious circle must be broken. “Investments in prevention must pay off,” says Berlinger. “And better health education is needed.” These are not expensive campaigns orchestrated by the BAG. It is about individual, responsible commitment. Berlinger could imagine that everyone with basic insurance would be entitled to a lifelong prevention amount of a definable amount.

However, advisor Merki Frey also addresses the insured. They – like doctors, physiotherapists and other freelance service providers – should be forced to use digital data processing. “The voluntariness must be lifted,” says Merki Frey. Efficiency and quality can only be increased and measured with a responsible effort if nobody can ignore the electronic patient file.

“How do I prevent a law from being enforced?” asks entrepreneur Berlinger. Answer: “By changing it over and over again.” She demands that the ‘pathological reformitis’ be finally stopped. In fact, we should finally ensure that the Health Insurance Act is finally ‘consistently enforced’. This applies in particular to the cost-effectiveness assessments of treatments and the quality requirements for service providers.

Legality is also a priority for health economist Heinz Locher. “Laws must be followed and violations must be punished,” he demands. If only by consistent application of the existing legal rules, part of the medical hocus-pocus could no longer be claimed through the basic insurance. And that could dampen the premium increase in the future.

Constantly changing staff

Do these kinds of ideas have a chance of being implemented in practice? Probably not, Merki Frey fears. “This year a new parliament with new members will be elected. The health committees will also be reassigned. And by the time everyone is inducted, half of the parliamentary term will already be over. And the election campaign begins again.”

The same applies to the new minister who will succeed Alain Berset. “As the new pope, she has no chance to make a difference. Ultimately, the Curia decides, that is, parliament. And the Curia failed.”