The radical suggestion by the head of CCS insurance Philomena Colatrella comes in the context of increasing concern about high health insurance costs in a country where having a private health insurance policy is compulsory.
The fact that health care costs and insurance premiums outstrip wage and GDP growth are also causing headaches for the Swiss government.
Indeed, the executive has a slew of measures on the table aimed at bringing down costs – including, for example, increased use of generic medicines – given that Swiss health spending was 11.1 of GDP percent in 2011 against an OECD average of 8.9 percent.
'Not revolutionary enough'
But CCS chief Colatrella believes many of the measures put forward by the government are not revolutionary enough.
Talking to the Sonntags Blick newspaper, she said raising insurance excesses to 5,000 francs or even 10,000 francs a year would mean savings of a billion francs a year for the health system.
Currently, people in Switzerland can choose their 'excess' – the higher the excess the lower the monthly premium, and vice versa. The smallest possible excess is 300 francs.
But Colatrella’s concept for an extreme makeover of the health system would, she admitted, change the existing model completely.
She said initial estimates showed drastically raising minimum excesses could bring down the monthly premium for basic insurance to 170 francs.
The insurance boss also argued these lower premiums would mean more money could be freed up to provide financial assistance to people who could not afford the higher excess.
The proposal by Colatrella also, in theory at least, puts the ball back in the consumer’s court on the question of individuals’ responsibility for their health. The rationale, also backed by the Swiss government, is that higher insurance excesses mean people do not run to the doctor if they have a minor health problem. This, in turn, so the thinking goes, reduces health care costs.
'The whole point of the health insurance is gone'
However, critics were quick to attack the idea.
“When the costs of this social safety net [that is, the health insurance system] don’t come out of the monthly premiums then the whole point of having health insurance is gone,” said the head of patient rights group SPO.
In Switzerland, individuals who cannot afford their health care costs can request financial assistance from local authorities. With the current low excess costs, relatively few people do take this route. But under Colatrella’s scheme, far more people would need to request that assistance. The final outcome would see that assistance coming out of people’s pockets in the form of tax.
For national councillor and Socialist Party Vice President, Barbara Gysi, the problem is even worse: “Once again the burden is being placed on those who can least afford it,” she told Swiss news portal 20 minutes.
Fellow Socialist Party politician Hans Stöckli said older and chronically ill patients would be the ones to suffer most.
And according to Swiss health economist Heinz Locher: “The purpose of the excess is to stop people going to the doctor for every little niggle. But if [excesses] were raised drastically, lots of people would not go to the doctor despite being sick.”