Column by Stefan Meierhans: The pitfalls of additional health insurance

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Doing something good for yourself on bad days – I understand that very well. It just needs to be determined what ‘good’ actually is, what it consists of – and what a hospital can rightly charge for it. If this is not regulated, stimuli arise that are bad from the perspective of all patients.

But one after another.

What are the benefits of additional insurance? Low room occupancy, longer visiting hours and…? Don’t worry if you don’t know what to do here: no one knows for sure, because the additional services that are additionally insured are not clearly defined anywhere. Sometimes it’s a bouquet of flowers on the bed or a larger menu selection – usually it’s probably better hotel service. It usually does not go much further than that, as can be deduced from the costs that the hospitals themselves indicate: on average they do not even amount to 700 francs per case. However, your additional insurance will be charged just under 9,000 francs per case. Do you now understand why you are a gold mine?

And now part of why you need to be vigilant: Because patients with supplemental insurance are such a lucrative business (see my 2021 research), they are sometimes recommended to undergo procedures that are not absolutely medically necessary – or, in the worst case, harmful and risky. .

Unfortunately this has been proven.

A 2023 study from the University of Basel and the Cantonal Hospital of Aarau concludes: “Patients with additional private insurance in Switzerland are more likely to have a cardiological procedure than those who have only basic insurance.” In 2022, the Handelszeitung wrote about a small clinic in Basel that specializes in orthopedic procedures: “(There) those with additional insurance cover two-thirds of the margin, although only a third of the treatments go to people with private and semi-private insurance. “

The results of a study by the Federal Public Service of Health (from 2016) are also striking: “Services from the orthopedic sector seem particularly interesting.” It found that those with semi-private or private supplementary insurance in Switzerland were 2.2 times more likely to have knee surgery and 1.5 times more likely to have spine surgery. Hip joints were replaced 1.3 times more often.

These are disturbing results, not only for people with additional insurance, but also very bad news for everyone with basic insurance: the lion’s share of medical treatments for people with additional insurance are of course covered by basic insurance: if those with additional insurance insurance policies are treated unnecessarily, this drives up the costs of basic insurance – resulting in premiums rising.

That is why I have been demanding for years that commitment should finally be created here, which means that services are defined and given a price tag. The supplementary insurance industry wants to solve the problem with an industry framework. The new regulations must be implemented by the end of 2024. Unfortunately, it leaves a lot of wiggle room and has achieved little in terms of numbers so far. My conclusion: a light solution does not work, now the screw must be tightened with a view to premium growth. What is needed here is, on the one hand, the supervisory authority for the financial markets, Finma, but perhaps one day also the legislature. One thing is certain: there can be no ‘business as usual’.

Source:Blick