At CSS and Helsana, the costs of basic insurance have increased significantly. Are these harbingers of even higher health insurance premiums? The reasons and how the trend can be stopped
The Swiss population is already groaning under the high health insurance premiums – and the costs of basic insurance continue to rise. This suggests even higher premiums in the coming years. In 2024 they rose by an average of 8.7 percent and in the previous year by 6.6 percent.
Two of the largest Swiss health insurance companies, CSS and Helsana, announced when presenting their business results that they had incurred losses on basic insurance in 2023 – at CSS it was 181 million francs and at Helsana 220 million francs. For both, the costs of basic insurance rose significantly last year: by 8 percent for CSS and by 4.7 percent for Helsana.
Will the costs continue to rise significantly?
The price question now is whether this is primarily a catch-up effect from the corona pandemic – many operations could not take place at the time – or whether the costs of basic insurance have reached a new plateau from which they will increase even further.
Bern health economist Heinz Locher assumes the latter. He doesn’t want to paint a pessimistic picture, he says, “but the population should prepare for further significant increases in health insurance premiums in the coming years.” The Swiss healthcare system is in a very challenging situation and there is a risk of increasing financial difficulties. The situation could get even worse in the coming years, as personnel costs could rise significantly again due to the shortage of skilled workers.
High demands as a cost driver
The health insurance companies and health experts surveyed give several reasons for the sharp increase in expenses for basic insurance.
Higher cost of medication: The CSS spent 5.73 billion francs on treatments last year. Medicines were the largest cost item and accounted for 23 percent of expenditure.
A large increase in some preparations against multiple sclerosis has been observed, says CSS boss Philomena Colatrella. Increasing expenditure can also be seen for certain cancer drugs – for the treatment of multiple myeloma and breast cancer. In both groups, patients received more services. In addition, very high prices are charged for drugs against rare diseases. A drug for a rare eye cancer costs more than 400,000 francs per year. Medication for a rare metabolic disorder can cost up to 1.2 million francs annually.
In the future, the new weight-loss injections that were originally developed for the treatment of diabetes could result in higher costs. Ultimately, the high number of patients potentially requiring treatment runs into the millions, says Colatrella.
Expenses for inpatient hospital treatment: “We are seeing further catch-up effects from the time when inpatient procedures were not possible at the request of the Federal Council,” says the CSS boss. Expenditure on inpatient hospital treatment accounted for 20 percent of treatment costs, making it the second largest cost item.
Expansion of the catalog of benefits in basic insurance: In addition, benefits from the Insurance Contract Act (VVG), to which supplementary insurance is subject, are repeatedly being moved to compulsory health insurance (OKP), says Colatrella. This makes basic insurance more expensive because the catalog of benefits is being expanded. This also increases costs.
Higher demands among the population: According to experts, the increase in health insurance premiums also has a lot to do with the high demands of the population. They want to afford ever better and more expensive treatments. This dynamic is particularly evident in urban areas and also among younger Generation Z patients. This could suggest that the attitude of entitlement among the population is not likely to be a temporary phenomenon.
Incentives for “overtreatment” in the system: When it comes to healthcare costs, you also have to talk about the supply side, not just the demand side, it goes on to say. The current system creates incentives for “overtreatment”. For example, if a hospital has purchased expensive new equipment, there would be an incentive to put it into operation regularly. In contrast to other countries, there are too few mechanisms in Switzerland that cause service providers to be more reserved when it comes to treatments and operations.
What should be done in the health system
The experts give some advice on what should be done to prevent imbalance in the Swiss healthcare system.
Browse the basic insurance catalog: Basel professor Stefan Felder, for example, advocates urgently searching through the catalog of basic insurance benefits. In recent years, politicians have expanded the range of benefits too much. The federal government neglected its duty to check the effectiveness and cost-effectiveness of services.
In the case of weight-loss injections, for example, it is very important to limit the delivery depending on the diagnosis, say health economists. Otherwise, this could become a bottomless pit in terms of spending. The patients usually need the injections for life.
From Locher’s perspective, there are some tools that could be used to curb costs. But they are used too little. He recommends checking the costs of compulsory health insurance using Health Technology Assessments (HTA). Indication boards are also useful. Here, multidisciplinary teams advise on the medical procedure instead of a single doctor. Another approach is “Smarter Medicine”. Medical treatments that are unnecessary are listed here.
Adaptation of the franchise: Felder has also advocated an increase in the minimum deductible from the current 300 francs. If patients had to contribute more to the costs of medical treatment, they would probably go to the doctor less often. The income from the higher deductible could be used to reduce health insurance premiums.
Make service providers more responsible: Experts are also calling for greater use of flat rates per case. Medical services are reimbursed per treatment case, which is intended to limit costs.