The top two Swiss health insurers, Helsana and CSS, are arranging to send patients to Germany where many operations cost half as much as in Switzerland.
Helsana has also compiled a blacklist of expensive Swiss clinics, with the aim of rewarding clients who stay away from them.
Cross-border operations are the latest money-saving strategy from Swiss insurers, eager to put the brakes on ever-increasing healthcare costs.
Health costs in Switzerland increased in 2003 by more than four per cent to almost SFr50 billion ($39.5 billion). All key players in the healthcare sector have been blamed for the rising costs.
Any of CSS's 200,000 clients with supplementary insurance who need orthopaedic or heart operations can now go under the knife in Germany.
The two clinics selected by the Swiss insurers are the Bad Krozingen heart centre and the Helios Orthopaedic clinic in Breisach, both roughly 60km from Basel.
A spokesman for Helsana, Christian Beusch, told swissinfo that it was close to concluding negotiations with the Bad Krozingen heart centre. The option of surgery in Germany will soon be open to most of Helsana's clients with basic insurance cover.
In another initiative, Helsana has compiled a blacklist of "extremely expensive" Swiss clinics, rewarding clients who avoid them. Helsana emphasised that the blacklist only relates to costs and not quality of care or treatment.
"Naturally we prefer our patients to go to clinics that are not extremely expensive so we are giving a premium discount to clients who attend less expensive clinics," Beusch explained.
Helsana is also considering sending patients beyond Europe for treatment in the future. "We envisage being in a position to send patients to highly specialised clinics in America and Asia in the longer term," he said.
CSS is offering a sweetener of SFr500 per patient as compensation for having surgery in Germany. Alternatively, patients can choose for their family members' visits to be subsidised. There is no special incentive from Helsana.
Price differences for the same operations in the two neighbouring countries are staggering, with coronary artery interventions more than SFr22,000 cheaper in Germany than in Switzerland.
Some Swiss patients are already undergoing post-operative treatment in Germany, but this is the first time surgery referrals have been arranged. Beusch confirmed that around 200 Helsana patients had travelled to Germany for treatment over the past two years.
The insurers' initiative comes as the federal authorities and the pharmaceutical industry reached a deal which should cut drugs prices by at least SFr250 million a year from 2006.
Representatives of the Federal Health Office and the pharmaceutical industry said the move was aimed at reducing the gap between the price of medication in Switzerland and other European countries.
The measures, which are due to come into force by the middle of next year, will apply to brand medicines and non-brand generic drugs.
The price cuts will also reduce health insurance premiums by about one per cent, according to Federal Health Office Director Thomas Zeltner.
Parliament is currently debating the next health issue on the table: the financing of hospitals.
The model proposed by the government involves equal financing shared between the health insurers and the cantons.
Zeltner told swissinfo that hospital financing was the most important reform from the set of reforms currently being worked on.
"Secondly we are trying to bring in freedom of contracting in the field of private practitioners and that package of legislation will also come before parliament."
Zeltner said his department was reviewing the whole gamut of benefits paid by health insurance step by step to see where there were savings to be made.
Swiss health costs stood at SFr49.9 billion in 2003, accounting for 11.5% of GDP.
Health-insurance companies paid 32.6% of the costs, while patients paid 31.5%.
In 2004 costs of overnight hospital treatment increased by 11.1%.
A coronary-artery intervention which costs SFr19,000 in Germany costs SFr41,000 in Switzerland.
In compliance with the JTI standards