Cost increase objectives in OKP

Joint position

• of the FMH, the Swiss Medical Association,
• Helsana Insurance Company Ltd and
• the umbrella association for health GELIKO (Swiss Health League Conference) 

The plans of the Federal Council to introduce a target cost increase for compulsory health insurance (OKP) fill GELIKO, Helsana and FMH with concern. Doctors, patients and insured persons would all like to assume that medical care and decision making is based exclusively on medical indications and not overridden by political stipulations. The targeted cost increases in OKP however, seem very much like a budget negotiated on political terms. This can lead to necessary benefits being withheld as they are no longer funded. It would be false advertising to promise patients and insured persons that their cover will remain the same while placing a limit on the costs. This objective claims to reduce medically unnecessary benefits without reducing those that are medically necessary. They cannot live up to this claim because it is an unspecific measure. The objective potentially limits all medical benefits, regardless of whether they are medically necessary or are judged not to be.

Inefficiencies in service provision need to be identified in order to combat them. This was parliament’s objective in 2019 when it voted for the partial revision of the Federal Health Insurance Act “Strengthening quality and cost-effectiveness” which set out that benefits need to be provided efficiently and cost-effectively, to the necessary quality standards. This revision entered into force in April 2021. It has not yet been possible to gather real-life medical experience of its impact. Similarly, there is no real-life experience of the impact of the new approval regulations for service providers. Law makers are therefore called upon to wait and see the impact the existing statutory provisions before tackling the same political goal with new legislative changes.

Over the last ten years, the net insurance benefits have increased on average by 2.5% per capita and year. This value is below the global target benchmark set for OKP cost growth by the Diener expert report in 2017. This legislative activism in health insurance is therefore unjustified. There is even a risk of further legal regulation creating an incoherent legal framework.

GELIKO, Helsana and FMH are pleading for legislative measures to be tested for implementability. The establishment of targets would involve large administrative and financial effort. Furthermore they require a top-down approach which does not reflect our health system.

Significant savings opportunities can be realised with the financial reform EFAS and the new tariff structure for outpatient care TARDOC without calling into question the achievements of our healthcare and patient satisfaction with their medical care.