Switzerland’s Federal Council recently released a complete report responding to parliamentary inquiries regarding the rising costs of healthcare and the scope of benefits covered under the nation’s compulsory health insurance system. The review, prompted by concerns over affordability and efficiency, assesses the current framework for evaluating new medical technologies and treatments. Findings indicate a prosperous Health Technology Assessment (HTA) program delivering significant savings, while also highlighting areas for betterment in program implementation and stakeholder engagement amid escalating national healthcare expenditures which reached 95 billion Swiss francs in 2023.
The Swiss Federal Council has released a report addressing concerns over healthcare costs, prompted by parliamentary inquiries regarding the scope of basic health insurance coverage and the evaluation of health technologies. The findings come as rising healthcare expenditures continue to be a key economic issue in Switzerland.
Review of Benefit Packages Reveals Cost Drivers
In 2023, total healthcare spending in Switzerland reached 95 billion Swiss francs, with approximately 52 billion francs allocated to services covered by basic health insurance. This includes medical examinations, medications, laboratory tests, and assistive devices. Funding for these services is largely derived from premiums paid by insured individuals, totaling around 36 billion francs. Premiums now finance roughly 38% of total healthcare costs, a significant increase from approximately 30% in 1996, the year the Federal Health Insurance Act (LAMal) was introduced. Over the same period, per-person costs for basic health insurance have risen from 1,723 to 4,482 Swiss francs.
The report indicates that this cost increase since 1996 is attributable to a combination of demographic shifts, advancements in medical technology, increased utilization of services, and structural incentives within the pricing system. Expanding the range of covered services alone does not fully explain the trend, as adding new benefits can sometimes lead to long-term savings by replacing less effective treatments or reducing the need for other costly procedures.
One inquiry asked the Federal Council to assess the possibility of transferring certain benefits from basic health insurance to supplemental insurance plans without compromising essential care. However, the report states that such a move could create a two-tiered healthcare system, which the Federal Council opposes. The principle of regular review – evaluating the effectiveness, appropriateness, and cost-effectiveness (EAE criteria) of all covered services – remains central to the system. Benefits failing to meet these criteria are not covered by basic insurance.
Assessment of the Confederation’s Health Technology Assessment Program
Switzerland’s Health Technology Assessment (HTA) program is an internationally recognized process for evaluating the value of healthcare services covered by basic insurance. Independent institutions conduct these assessments and provide recommendations to the Federal Office of Public Health (FOPH) and the Department of Home Affairs. These agencies then decide whether to reimburse, eliminate, or limit coverage for the assessed service.
A separate inquiry requested a detailed assessment of the FOPH’s HTA practices, identifying key challenges and proposing solutions to enhance program efficiency. It also asked the Federal Council to consider establishing an independent HTA agency.
The report demonstrates the effectiveness of the HTA program, noting that it has led to the removal of coverage for ineffective services, resulting in annual savings of 150 million Swiss francs. These direct savings are supplemented by indirect savings stemming from improvements in treatment quality and care. However, the report emphasizes the need to evaluate a wider range of services to further enhance efficiency, requiring increased engagement from relevant stakeholders. The FOPH has begun to address this by strengthening collaboration with prio.swiss, the association of Swiss health insurers.
Improved communication of HTA results is also crucial for ensuring that reimbursement decisions are implemented effectively. The FOPH should also conduct periodic evaluations to assess the implementation of these decisions. The Federal Council notes that the FOPH has already taken steps to improve the dissemination of HTA findings. While periodic evaluations are considered worthwhile, they would require a thorough assessment of available resources.
Currently, a section within the FOPH coordinates the Confederation’s HTA program, while external agencies conduct the actual assessments. The report concludes that creating a new independent agency would incur additional costs, and it identifies no structural deficiencies that would justify these expenses.
