The Helsana standard gives service providers a transparent view of the mission and role of health insurance. It sets out the procedures and overall conditions for reviewing benefits.
The costs of long-term healthcare will continue to rise: from 7.3 billion CHF in 2005 to an estimated figure of about 18 billion CHF by 2030. The reason for this increase is that people born in the baby boom years, when the birth rate was high, are now reaching retirement age. Life expectancy for the population in general has also increased.
Against a backdrop of demographic change and rising costs, monitoring and control of healthcare benefits under compulsory healthcare insurance (OKP) are becoming ever more important. Among the compulsory OKP benefits, care services are now numbered among the five largest cost blocks.
For long-term healthcare, the OKP reimburses a proportion of the costs of care and nursing services in connection with the diagnosis or treatment of an illness and its consequences. These include services provided by nursing homes, organisations offering healthcare at home, and healthcare professionals. This standard is intended for these service providers.
Health insurers and service providers have to work together. Helsana believes it is important to inform service providers about the procedure for monitoring and controlling benefits. Helsana offers professional healthcare controlling for service providers and policyholders. Our healthcare controllers are trained specialists who can be contacted locally and at our service centre.
By publishing the Helsana standard for healthcare controlling, Helsana aims to create transparency and to lay the foundations for good collaboration. The basis for Helsana's work is a cooperative working relationship with service providers. The objective is an efficient benefits controlling procedure in the interests of both parties.