For fear of an influx of customers: are health insurers demanding too high premiums?

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Before SP Health Minister Alain Berset (51) recently announced the latest premium shock, one of his employees projected a diagram on the wall that should explain the whole misery: one column shows the income, the other the costs of the health insurers.

They are higher – and that is where the dog is buried. Because insurers spend more than they earn, premiums have to increase.

One reason for the high costs is the migration of policyholders to cheaper health insurers. Because many more providers changed providers in 2022 than were taken into account in the premium calculation, another increase was inevitable. Nevertheless, Health Minister Berset advised those who are particularly hard hit to switch to a cheaper health insurance fund – and therefore his successor will probably be at the same point again next year.

Basel Federal Councilor Sarah Wyss (35) no longer wants to play this game. The many health insurers burden healthcare with at least 130 million francs annually, she writes in an essay. This is fatal for health insurers: personnel costs are rising and higher reserves are needed.

60 additional features at KPT

This was also the case for the Bernese health insurer KPT. Because it offered by far the cheapest offer of basic insurance, it was flooded with new customers – and at the beginning of this year it suddenly had 195,000 insured people, or 55 percent more.

To cope with the crowds, 60 additional vacancies have been created and letters have been sent to customers asking for their understanding if the refund would take a little longer.

The social democrat Wyss doubts the sustainability of this system and even speaks of a ‘KPT effect’ and false incentives. And she has a suspicion: that insurers are artificially setting their premiums slightly too high to prevent a rush of new customers: “The health insurance system is being shaken to its foundations, competition is no longer an issue, and if there is no longer any incentive to to offer the lowest possible premiums.”

Wyss wants to know before the winter session of the Federal Council whether he also believes that health insurers are charging higher premiums to attract fewer people interested in short-term changes.

No approval for excessive profits

The Federal Office for Public Health does not want to know anything about a “KPT effect”. There are mechanisms that prevent an insurer from setting premiums too high, BAG spokesperson Andrea Arcidiacono told SonntagsBlick. “Because no profit is allowed to be made, reserves will continue to increase if premiums are systematically too high.” If these provisions threatened to increase excessively, approval would be denied.

Health insurer Santésuisse denies any reality of Sarah Wyss’ theory. Spokesman Matthias Müller: “The goal is always to acquire additional customers.” Insurers face fierce competition. Mainly for this reason, the administration costs are relatively low at 5 percent: “The premiums are calculated as narrowly as possible. If things had been different, reserves would not have shrunk so much and premiums would have risen considerably more over the past year. According to Müller, medium-sized and large health insurers have no problems attracting customers, because they can easily accommodate this with the existing infrastructure.

Wyss maintains that the ‘KPT effect’ pulverizes the health insurers’ argument that competition causes costs to fall and quality to increase: ‘Health insurers are no longer interested in being the cheapest provider.’

The SP health politician already has a solution to this dilemma: public health insurance.

Source:Blick