October 2016

Healthcare costs and their influencing factors

Healthcare costs and annual increases in health insurance premiums are a major concern for the general public. Where do these costs come from and what are the key systemic factors behind them? The main influencing factors are outlined below.

The five main cost drivers

Fact 2 The more we go to the doctor, take medicine or require care, the greater the cost of those benefits which make up health insurance premiums. There are many reasons behind the cost increase, the main ones being medical and technological progress, new medication, our rapidly ageing society and the rising claims of insured people who are consistently claiming more benefits. More on premium growth

Healthcare cheaper than road traffic

Fact 1 Healthcare costs in Switzerland amounted to CHF 71.2 billion in 2014. This amount was financed by basic insurance (a little over a third), private households (just under a quarter) and the state (a fifth).

By comparison: we spend more on road traffic than we do on our health: over CHF 80 billion a year.

Every franc paid in premiums is broken down as follows

Fact 5 Health insurers must pay all the claims from the basic insurance catalogue from their premium income. Each franc is broken down as follows: 23 Rappen Inpatient treatment, 20 Rappen Doctors, 17 Rappen Medication, 16 Rappen Outpatient treatment, 10 Rappen Care, 8 Rappen Other services, 6 Rappen Operating expenses for health insurance. Any surplus is added to the reserves.

Demography

Fact 3 The proportion of old people in Switzerland is growing fast; the post-war baby boom is on the cusp of the third age. This demographic shift is a cost driver that cannot be influenced: by 2030 the number of people requiring care will have increased by 42 percent – from 127 600 to 182 000 senior citizens.

Unnecessary regulation paralysing health insurance

Fact 4 The state continually wants to play a bigger role in healthcare. State regulation is increasing. That means health insurers are being impeded greatly in their legal mandate to curb the growth in the cost of healthcare and health insurance.

Helsana supports lower healthcare costs as follows: Interview with CEO Daniel H. Schmutz

Misplaced incentives

Fact 7 There are misplaced incentives in the healthcare system. When recommendations are made for unnecessary therapy or operations, it affects the quality of medical care. This practice can lead to painful post-operative care for patients and increase costs at the same time. Unnecessary healthcare costs also arise through inefficient service provision, distorted prices and dated pricing structures.

Hospitals are in a type of premium-funded arms race

Fact 8 The cantons decide how many hospitals to have in their area. They are currently investing millions in major hospital construction projects – all working individually instead of coordinating their efforts. All at the expense of the premium payer. More cooperation would save a lot of money as expensive equipment and bed space could be exploited more effectively. This arms race is leading to an infrastructure that is much too big and expensive for our country.

Too much / not enough care

Fact 6 Too much therapy can be as harmful as not enough. The wrong type of therapy is also dangerous – the wrong medication or a risky operation when physiotherapy would bring less risk for more reward. Too much or not enough care can be avoided through thorough advice. The decision on what therapy to take does not lie solely with the doctor, it’s also up to the patient. Health insurers play an important advisory role in this regard. Complementary medicine is a good example: it has so many applications and if one doesn't work, the patient just moves on to the next one. However a “therapy marathon” can overload the body. That's why Helsana provides an independent Centre for complementary medicine. It is also incidentally the only health insurer in Switzerland to offer such a service. We help you find the right therapy to get your health back as quickly as possible.

What about screening tests? They aren’t all advisable. On the Health Literacy page, you can see videos outlining the pros and cons of early recognition programmes for breast cancer, prostate cancer and bowel cancer.

Text: Daniela Diener