Current efforts to contain health costs
06 November 2024 | Comment(s) |
Benoît Michellod
Like all young people her age, my daughter is active on social networks. She also follows Groupe Mutuel publications (on my recommendation). Last week, she asked me about our two recent blogs on containing health costs. She remarked that although it was interesting to talk about containing costs, it would be even more interesting to suggest concrete measures!
Dad, what concrete measures is Groupe Mutuel proposing to take to limit health costs in Switzerland?
In Groupe Mutuel's view, we need to work on a number of areas if we are to achieve our goal of containing and reducing health costs. For example, we believe that hospital planning should be carried out at regional or supra-regional level rather than at cantonal level. We also need to work on drug prices and access to the health system. In addition, the Value-Based Healthcare concept needs to be developed and generalised, cost-sharing needs to be adapted and the scope of the catalogue of benefits needs to be discussed. Finally, we must also promote the digitalisation of the health system and support for prevention.
What is Value-Based Healthcare?
In the Swiss health system, remuneration is currently based on the quantity of services provided. As a result, healthcare providers have no incentive to deliver optimal care (using resources efficiently, taking into account the value for patients), but rather maximum care (providing all possible services).
The aim of Value-Based Healthcare is to change this approach. Remuneration systems will need to reward the quality rather than the quantity of services provided. The aim is to optimise the final effect and benefits for patients, using an approach based on the usefulness, quality and added value of the services provided.
Why could inter-cantonal hospital planning help keep health costs down?
Firstly, inpatient treatments account for a large proportion of the costs borne by the compulsory health insurance (AOS/OKP). So even a small effect can result in cost reductions of millions of francs. Moreover, it is very difficult for a canton to reduce its hospital provision. Hospitals are represented as major employers and bring prestige. In principle, hospital services are more important to the public than any associated financial difficulties. As a result, Switzerland has one of the highest hospital densities in Europe, with 99.8% of the Swiss population able to get to a hospital in less than 30 minutes.
Placing hospital planning on a regional level would enable more rational decisions to be taken in the area of healthcare, thus promoting the quality of care. In 2018, 46% of hospitals did not achieve the required minimum occupancy rate. It is therefore important to favour a certain degree of centralisation in order to develop centres of expertise and optimise the coordination, management and efficiency of care.
What do you suggest in relation to drug prices?
Measures have already been taken recently by the Federal Council. Parliament also wants to amend the Law on Health Insurance (LAMal/KVG) and promote price models (reimbursement of a certain amount by pharmaceutical companies) and provisional prices.
For Groupe Mutuel, other measures are still necessary. For example, it should finally be possible to reimburse the cost of medicines purchased abroad, provided that they are prescribed in Switzerland and that foreign prices are lower than Swiss prices. In addition, a reference price model should be introduced. This would make it possible to limit financing by the AOS/OKP to the most advantageous drug in each reference group.
Why should cost-sharing amounts be adapted to healthcare costs?
The most recent changes to deductible amounts date back several years: 2004 for the ordinary deductible and 2005 for optional deductibles. In order to take account of the increase in costs since then, cost-sharing amounts for insured persons should also be adjusted. The ratio between the standard deductible and gross costs per person should be maintained at the same level as when the LAMal/KVG was introduced. The deductible amount plays a moderating role in the use of health services.
Don't you think there should be a limit on the benefits paid for by compulsory health insurance (AOS/OKP)?
Yes. The catalogue of services covered by basic health insurance is currently very broad. If we review the evolution of the relative share of each contributor to healthcare costs in Switzerland between 2000 and 2020, we can see that the proportion paid by basic health insurance has risen from 32% to 38%. This means that more and more care is being financed by basic insurance, which partly explains the rise in premiums. We therefore recommend to evaluate the benefits covered by compulsory health insurance.
However, this is difficult because there is no exhaustive list of services covered, but the principle of trust applies. It is also a highly emotional and ethical subject, as it has a direct impact on the care of some patients.
What would need to be done to bring these proposals into force?
Overall, there is a need to strengthen dialogue between the various players in the Swiss healthcare system (insurers, pharmacies, cantons, hospitals, doctors, etc.). Groupe Mutuel is therefore calling for the creation of a task force responsible for rapidly deciding on and implementing effective measures needed to control healthcare costs. Only if everyone contributes to this effort will it be possible to limit the costs borne by the health insurance in the medium term.
