Swiss patients may end up under a German knife
Swiss patients may soon end up in German operating theatres if plans by health insurer CSS are realised.
The company says that runaway health costs in Switzerland are forcing it to look to the country’s neighbour for cheaper operations.
Lucerne-based CSS is looking in particular at carrying out heart bypasses, hysterectomies and hip replacements outside Switzerland.
The potential savings are substantial. At the University Hospital in Lausanne, for example, orthopaedic surgery alone costs SFr28,400 ($23,699). The same operation in the German town of Rheinfelden would cost SFr19,900, with two weeks’ convalescence thrown in.
The company has already made huge savings by sending patients to hospitals in the German Black Forest for convalescence.
But sending patients abroad for surgery is problematic because Swiss law forbids local insurers from paying for operations outside Switzerland, except in emergencies, or if the patient holds additional insurance.
To qualify for treatment abroad, CSS patients would have to have additional insurance cover beyond the mandatory basic insurance.
Spouse in tow
CSS spokesman Stephan Michel told swissinfo that the company already had a contract with a German clinic in Bad Säckingen for rehabilitation treatment at a cost of SFr187 a day. In Switzerland the same treatment can cost as much as SFr600.
The company is hoping to persuade more of the 180,000 people paying private insurance premiums to convalesce in Germany next year thanks to a special offer.
“At the German price,” said Michel, “we can afford to send the patient’s partner with them, at no extra cost to the patient.”
The company says the cost savings would be passed on to the holders of top-up insurance policies.
Michel says his company’s plans have already prompted hospitals in Switzerland to take a closer look at their cost structures.
Cheaper operations
“At the moment, all operations in Switzerland are very pricey, with hardly any distinction made between so-called “cheap” and “expensive” ones.
“We are in talks with some providers who have signalled a willingness to bring down the cost of operations that are simpler to perform.”
Margrit Kessler, president of the Swiss Patients Association, agrees that cheaper alternatives are needed, but worries that patients could be coerced into travelling abroad for operations.
She is also concerned about technical and legal complications. “What happens if something goes wrong and the patient is in Germany, while his or her relatives are in Switzerland? Legally, would Swiss or German judges have jurisdiction?”
Michel conceded that the company had yet to look into the legal questions but says they are unlikely to be problematic as many patients already have the necessary insurance cover.
The Federal Health Office is currently considering the issue and has set up a working group to consider how the law could be changed to allow patients to cross the border for medical treatment.
Too many hospitals
The reason medical costs in Switzerland are so high has to do with infrastructure costs and salaries but, according to Michel of CSS, the real problem is overcapacity.
“There are many [rehabilitation] clinics that have perhaps a 60 per-cent occupation rate and prices can only fall if the rate is between 80 and 90 per cent.”
He added that there were too many hospitals in Switzerland, and many were small and too expensive to run.
The Association of Hospital Head Doctors reacted with scepticism to CSS’s proposals.
“It’s a game the health insurers are playing with the newspapers [which wrote about their plans]. It’s like throwing a pebble into water and waiting to watch the ripples,” said Dr Hans-Ueli Würsten, the association’s president.
Who pays?
“Healthcare has its price and the health insurers do not want to pay up [even though] most of the costs are borne by the patient, who are willing to bear the expense of being cured [when they need treatment],” Würsten added.
The head doctor also said the target group was unlikely to want to go abroad for operations. “They will not want go to Germany – it’s difficult enough to send them from Biel to Montana!”
It was also doubtful that the premium-payer would benefit from significant cost savings, said Würsten, because only the cost of the additional insurance would fall and not that of the basic insurance.
swissinfo, Faryal Mirza
Costs for obligatory health insurance rose by 24 per cent between 1999 and 2003.
Premiums rose this year by around four per cent.
CSS has 1.2 million policyholders.
Every seventh Swiss person is insured with CSS.
Health insurer CSS is looking into sending patients to Germany for operations.
It says the cost savings would be enormous as operations in Switzerland can be twice as expensive as those in Germany.
Only those with additional health insurance would be eligible.
The Swiss Patients Association and the Association of Hospital Head Doctors are sceptical.
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