Plan for "patients' tax" causes outcry


The Swiss government's plan to charge patients SFr30 ($26.40) per consultation at the doctor's has caused consternation among patients groups and medics themselves.

This content was published on May 7, 2009 minutes

The move is part of a larger package of measures aimed at stemming the rise in health costs.

"Everyone says that the Swiss health system is a good one, but it is in danger," said Interior Minister Pascal Couchepin, as he announced the plans on Wednesday.

In 2008 the costs associated with obligatory health insurance – the core coverage that every resident must purchase – were estimated at SFr2,973 per capita. This was a rise of 3.9 per cent on 2007.

In addition, the difficult economic situation has led to losses among insurers, amounting to SFr800 million in 2008, reducing their financial reserves. The gap could expand to SFr1.4 billion in 2009, officials warned.

Couchepin, who is in charge of the health portfolio, said that the government's measures could result in savings of up to SFr400 million. The proposals, many of which have already been discussed with health officials and professionals, still have to go before parliament.

Under the proposal, health insurance companies will have to offer free telephone medical services as a first port of call.

The government also favours a one-off payment of SFr200 million to help reduce health insurance premiums in 2010 and 2011.

However, the most controversial move is that patients would have to pay SFr30 up front per medical visit. There are some provisos: People under the age of 19 years old and pregnant women would be exempted, as would the chronically ill after the seventh visit.

"Absolutely unacceptable"

"This is an absolutely unacceptable proposal," Margrit Kessler, president of the Swiss Patients Association, told swissinfo.

"For years health insurance premiums have not gone up sufficiently and the insurers' reserves have as a result been weakened," she said, adding that it would be the patients alone who would bear the consequences if the plans were accepted.

Kessler believes that the benefits are minimal. "The gain will be nullified by the administrative costs needed to collect the tax," she said.

For her, this way of proceeding is not democratic, and she hopes that parliament will reject the measures.

But she does – based on good experiences so far - welcome the idea of telephone consultations, so long as it is not imposed and services are also available in Albanian and Turkish.

"Often foreigners have language problems, they are unsure of themselves and therefore go to hospital for minor complaints," said Kessler.

Politicians' criticisms

Most political parties have attacked Couchepin's proposals. The rightwing Swiss People's Party has accused the minister of not being able to come up with good ideas for tackling the health costs problem. And Switzerland's cherished process of direct democracy has not been taken into account, party officials said.

Even Couchepin's own centre-right Radical Party has reservations.

On the left of the political spectrum, the Social Democrats and the Green Party said that the tax would be counterproductive because people would put off going to the doctor, meaning more expensive treatments would be needed later on.

The Greens say that encouraging parallel imports, generic medicines and complementary treatments would all be better ways to reduce the financial health burden. Premiums should be linked to salaries.

Consumer groups have also criticised the proposals because the burden is placed on the patients.

Medics unconvinced

Doctors' concerns are similar. According to the Swiss Medical Association, the SFr30 charge goes against the spirit of solidarity as set out in the health insurance law.

"It's an administrative dinosaur," the association's president, Jacques de Haller, told the Swiss News Agency. He also sees it as "hindering the path to treatment" for those with lower incomes.

H+, the organisation representing Swiss hospitals, said it was "unconvinced" by the measures. It pointed to a higher administrative burden, as well as to the dangers of more state interference.

It went on to say attempts to introduce a patients' tax in Austria and Germany had ended with less-than-encouraging results.

Andrea Clementi, (Adapted from Italian by Isobel Leybold-Johnson)

German case

In 2004 Germany imposed a charge of €10 for all adults covered by statutory health insurance for the first doctor's visit every quarter. Excluded were children under 18 years old.

The number of doctors' visits in Germany, which historically had high levels of consultations, dropped significantly in the two years that followed (-8.7% between December 2003 and December 2004).

But from 2006, the number of consultations have been rising again, the causes of which are still being investigated.

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Telephone health lines

Currently several insurers offer medical telephone advisory services. If the insured person is willing to consult this first rather than go to their doctor, they receive a reduced premium.

In Scandinavian countries and Britain, online and telephone services are already widely in use, and according to surveys, are well accepted. In Switzerland, this type of service has only started to be developed in the past few years.

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