Government seeks to limit access to specialists to reduce healthcare costs

Direct access to specialist doctors would become much more difficult under the new reform plans. © Keystone/Gaetan Bally

The government wants to restrict direct access for patients to specialist doctors as part of plans to slow down a rise in costs for the Swiss health system.

Interior Minister Alain Berset, whose portfolio includes health matters, said the aim of a package of measures was to save about CHF1 billion ($1.1 billion), while boosting the quality and efficiency of health services.

The proposed measures, to be set by the national government and the 26 cantons annually, include a target for expenditures to be spent on medical services, hospital stays and drugs.

The plan foresees that the services of a specialist doctor will only be covered by compulsory health insurance if patients first consult a general practitioner, a telemedicine centre“ or a so-called health maintenance organisation (HMO) which act as gatekeepers.

Berset argued that most patients already follow this practice but that the government wanted to encourage more patients to join.

However, he downplayed concerns about spending caps, saying there was no intention to ration medical services.

Increased transparency, higher cost awareness is to be achieved through closer cooperation between the different players in the health sector, according to Berset.

The proposals, which also include an improved legal basis for winning access to innovative but costly medication, are now sent to cantons, political parties, institutions and organisations for consultation before the government presents its bill to parliament.

Cost saving measures

The package presented on Wednesday comes on the back of a first set of measures, launched two years ago, targeting generic drugs and outpatient services. The government said at the time it hoped to reduce costs by about CHF1 billion.

Discussions on the reform are ongoing in parliament.

In 2012, voters threw out a proposal to introduce a Managed Care system, creating clusters of doctors, therapists, hospitals and pharmacies.

Overall health costs in Switzerland are about CHF82 billion annually, including CHF33 billion covered by the mandatory health insurance plans, according to latest data from 2018 by the Federal Statistics Office.

The Swiss healthcare system is among the most expensive in the worldExternal link.