Inadequate medical care – health insurers identify potential improvement

Analyses featured in the latest Helsana report reveal deficiencies in medical care. When it comes to screening, participation rates are below the recommended target values. The picture for chronically ill patients is also equally sobering: less than half of diabetics receive care in accordance with the guidelines. The report also identifies unnecessary risks in terms of medication. One way of improving this situation would be for health insurers to advise patients of potential improvements in medical care. Regulatory requirements, however, prevent them from doing so.


Helsana has put the quality of medical care to the test in its latest Helsana report, “Provision of care”, based on specific care situations. The aim of this latest report is to show that Helsana can make an essential contribution to high-quality care. Health insurers have access to a great deal of data and are therefore able to identify potential improvements in medical care, as shown by the following examples.

Far too few bowel check-ups

Medical check­ups can help detect bowel cancer early, improving the chances of recovery. They are recommended for men and women between the ages of 50 and 75. Despite this, only between 50 and 60 percent of this age group have undergone one of the recommended medical check-ups in the last ten years. An increase in the participation rate would have numerous positive effects: alongside reducing individual suffering, it would also have a financial impact on the direct medical costs of this disease, which amount to roughly CHF 90 million annually.

Inadequate opioid prescriptions with fatal consequences

Painkillers are among the most frequently prescribed medication in the world. In 2022, half a million people in Switzerland were prescribed two or more painkillers within three months. One in four of those, that’s 125,000 people, were given an inadequate opioid prescription. According to the WHO, opioids are strong painkillers, some with a high risk of addiction, and should therefore be administered with care. Given the frequency and the potentially fatal health consequences, there is an urgent need for action.

Helsana creates transparency

Although nationwide tools for measuring quality are sparse, Switzerland has a healthcare system that is certified as efficient and of high quality. The question inevitably arises as to what evidence there is for this approach. “Helsana believes it is important to boost transparency regarding the quality of medical treatment vis-à-vis patients,” says Helsana CEO Roman Sonderegger. “As health insurers have access to a great deal of data about their policyholders’ health, they can identify specific improvements in medical care,” explains the CEO of Helsana. Helsana is therefore advocating that information from billing data be used to aid a higher quality of care – for the good of the patient.

To care report

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