Doctors hit back at claims of overcharging

Doctors throughout the country are checked using the same criteria Keystone

One in 20 doctors charged too much in 2004, according to a study published at the weekend by the umbrella organisation of health insurance companies, santésuisse.

This content was published on April 17, 2006 - 13:38

However, the Swiss Medical Association has rejected the criticism, arguing that the method of calculation was incorrect.

According to the study, nearly 12 per cent of doctors in Switzerland sent out bills that were 30 per cent higher than colleagues practising in the same canton.

santésuisse said that in three out of ten cases, the bills were unjustified.

Spokesman Peter Marbet confirmed a report in Sunday's Sonntagsblick newspaper that the organisation's control system had caught out one in 20 doctors, who had had to repay the amount overcharged.

In a first stage, the names of doctors whose bills are 30 per cent higher than the competition in their canton are put on a list.

They then receive a warning letter suggesting that they are perhaps prescribing too many drugs to their patients or treating them for too long.

Marbet said the number of doctors on the list in 2004 was 1,991. The figure was 1,265 in 2003.

Valid reasons

He added that two-thirds of the doctors on the list had valid reasons why they were more expensive and the health insurance companies accepted these.

The Swiss Medical Association has hit back at the findings of the study. "These figures take absolutely no account of reality," Jacques de Haller, the association's president told French-language Swiss television.

In particular he pointed out that santésuisse had not taken serious illnesses into account.

"A doctor who has many HIV positive or diabetic patients will be singled out because he is more expensive."

He added that there were "very, very few" black sheep among the profession.

Financial criterion

The Swiss Society of General Medicine also rejected the purely financial criterion of the insurers that defined when a doctor was too expensive.

It painted a picture that doctors were cheats which was far from the truth, the society said in a statement on Monday.

Marbet at santésuisse countered that the data were balanced according to the age and sex of the patients. A doctor with many old patients or women would have a higher turnover but this was taken into account.

He added that doctors throughout the country were checked using the same criteria.

swissinfo with agencies

In brief

Switzerland's largest health insurance company, Helsana, said that in 2005 it opposed 95,000 or 3.8% of the bills issued by doctors with their own practices.

The main causes of opposition were bad calculations and unjustified or useless prescriptions.

Doctors had to repay Helsana about SFr30 million ($23.28 million).

The law says that health insurance companies have the right to demand repayment for charges they consider excessive.

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