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New alternative insurance models

By Felix Schneuwly

13.10.2020

Source: iStock / sturti

Despite the overwhelming rejection of the managed care model in the referendum of 17 June 2012, more and more policyholders are purposely choosing alternative models for their basic insurance, saving 10-15% on premiums in the process – without sacrificing quality of medical care. Nowadays, over 70% of policyholders have an alternative insurance model. Furthermore, insurance companies collaborate with doctors and other medical service providers to create new alternative models every year.

In what ways do alternative models limit my freedom of choice?

All alternative insurance models have one thing in common: policyholders accept a limited choice of service providers (doctors, hospitals, pharmacies etc.) in exchange for a discount on their premiums. Insurance companies must prove how much an alternative insurance model saves in order for the Federal Office of Public Health (FOPH) to approve the premium discount.

Under almost all alternative insurance models, choice of provider is limited at the start of the diagnosis or treatment process. This is known as “gatekeeping”. If you have a Telmed model, you must first call a helpline. If you have a family doctor model, you first consult your family doctor. With an HMO model, you contact the medical centre. With a pharmacy model, you are obliged to purchase any medicine from a particular pharmacy or pharmacy chain. These models save money by preventing patients from going straight to a specialist or turning up at hospital emergency departments with minor ailments. And, with the coronavirus pandemic deterring people from visiting medical practices and hospitals for fear of catching the virus, many have now discovered first hand the benefits of telemedicine.

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How do alternative insurance models save me money?

You can save money without compromising on the quality of medical care provided. And in fact, models offering more than just “gatekeeping” actually improve quality: with data-driven coordination of complex treatments, patients are spared multiple assessments, the blind search for a suitable doctor or hospital and superfluous or even harmful operations. Here are two examples:

  • With the Multimed model from CSS, you can choose between different first points of contact in the event of illness: either a family doctor from a network/group practice or a telemedicine centre. In addition, you have access to digital support from myGuide. This online questionnaire dynamically orders your responses resulting in a recommendation regarding whether or not you need to see a doctor. Customers who have repeat prescriptions obtain their medicine from mail-order pharmacies.

  • From 1 January 2021, Assura (in German, French and Italian only) will offer a Qualimed model that is 90% the same as a traditional family doctor or telemedicine model in terms of the way it functions. If the family doctor or telemedicine centre decides that the patient needs treatment by a specialist in the field of cardiology, orthopaedics, urology or gastroenterology, the patient contacts the company BetterDoc, based in Basel. After analyzing the family doctor's report and a range of quality data (including training and qualifications, patient satisfaction and specialization), BetterDoc proposes the three most suitable specialists for the patient's situation. The patient can then choose one of them. The BetterDoc concept has provoked a hostile reception from Swiss doctors. Nevertheless, there is a future for data-driven diagnosis and treatment recommendations, not least because they surpass those made by family doctors who simply recommend their friends from medical school.
  • Author

    Felix Schneuwly

    Health & health insurance expert

    media@comparis.ch

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