Individuals insured by Swiss compulsory health insurance can choose between multiple deductible and insurance models. The standard compulsory health insurance model allows policyholders to visit any doctor or specialist without an initial screening. Managed care models require policyholders to be screened by a “gatekeeper” which may be a specific general practitioner, an HMO center or a telemedicine hotline, depending on the model.
An evaluation of data published by the Federal Office of Public Health (FOPH) by independent online comparison service moneyland.ch show that health insurance policy holders are turning their back on the standard insurance model and mid-range deductibles in increasing numbers. “The highest deductible and the managed care model are gaining in popularity,” concludes moneyland.ch analyst Felix Oeschger.
Standard model policies on the decline
While around 2.905 million residents were insured by standard compulsory health insurance policies in 2015, only around 2.575 million standard policies were in use in 2017. That is an 11% decline in standard policy use over a period during which the total number of policyholders increased by 150,000. The trend is visible across all age groups: Standard policies declined by 11% in the adult age group, by 12% in the child age group and by a high 14% in the young adult age group.
“It is apparent that ever more policyholders do not feel the value added by the standard model over managed care models is not enough to justify the premium markup of around 20% for standard model policies,” says moneyland.ch CEO Benjamin Manz.
Strong adoption of telemedicine model
The number of policyholders which hold telemedicine model policies has shown a significant increase. There are now several varieties of the telemedicine model. For example, some policies use a hybrid of the telemedicine and pharmacy models. What all telemedicine policies have in common is that barring a few exceptional circumstances, policyholders must contact a telemedicine center via a hotline before visiting a doctor, specialist or hospital. That is not always a disadvantage because the telemedicine hotline service personnel can provide basic medical consultation. The use of telemedicine policies showed a strong increase of 16% between 2015 and 2017. Adoption was highest in the adult age group at 17%.
HMO and family doctor models show small gains
The use of policies based on the family doctor (general practitioner) model increased by 7% in 2017 compared to 2015. Use of HMO policies increased by 3%. It is important to note that in practice, the HMO and family doctor models may overlap because some family doctor policies include joint medical practices in their general practitioner selections. In total, around 3.2 million individuals were insured by family doctor policies in 2017, while only 744,000 held HMO policies.
Mid-range deductible use on the decline
A deductible is the portion of covered expenses which a policyholder must pay out of their own pocket before the insurance begins to cover costs. In Swiss compulsory health insurance, the lowest possible deductible is sometimes referred to as the base deductible: The base deductible for children is 0 Swiss francs; the base deductible for young adults and adults is currently 300 francs. The highest possible deductible for children is 600 francs, while the deductible for young adults and adults can be as high as 2500 francs. All deductible options which fall between the base deductible and the highest possible deductible are referred to as mid-range deductibles.
Currently, there is a clear trend towards migration from mid-range deductibles to the highest possible deductible. The number of maximum-deductible policyholders in the child group increased by 35% between 2015 and 2017. The young adult age group showed an identical increase of 35%, while the maximum-deductible adoption rate in the adult age group over that period was 27%. Nearly 30% of young adults and more than 35% of adults held mid-range-deductible policies in 2015. In 2017, only 23% of young adults and around 31% of adults used mid-range deductibles.
The trend towards moving away from mid-range deductibles is logical and can be seen as a positive development. “Mid-range deductible models do not normally pay off and are never the logical choice, and moneyland.ch has always been very clear on this point,” says Felix Oeschger. Depending on individual healthcare expenses, the optimal deductible will always be either the lowest or the highest possible deductible.
Forecast: Changed to the Swiss compulsory health insurance landscape
“On the whole, we can expect to see further migration away from the standard model and mid-range deductibles,” believes Benjamin Manz. Mid-range deductibles are a poor choice for the majority of policyholders, while managed care health insurance models are a sensible choice for most policyholders. If current trends continue, the compulsory health insurance deductible and insurance models may have to be completely reconceptualized.
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