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HEALTH INSURANCE

Swiss health insurer forced to pay one million-franc hospital bill

In a landmark ruling the Swiss Federal Supreme Court has ruled there is no upper limit on the amount to be paid by health insurers when it comes to hospital treatments that meet legal requirements.

Swiss health insurer forced to pay one million-franc hospital bill
File photo: Depositphotos

The ruling relates to a 2014 case which saw a 71-year-old patient spend 421 days in a Basel hospital with serious complications after knee surgery.

Total medical costs were around 2.4 million Swiss francs (€2.1 million) with Swiss health insurer Vivao Sympany required to pay 45 percent of those costs, or 1.08 million francs, and the hospital to pay the remainder.

Read also: What you need to know before you take out Swiss health insurance

But the Basel-based insurer said it would only pay 300,000 Swiss francs.

The Basel hospital where the man had been treated then took the matter to a cantonal insurance tribunal which found in the hospital's favour.

Vivao Sympany appealed, arguing that the Federal Supreme Court had previously placed an upper limit on the liability of health insurance providers.

It also argued that according to calculations using the so-called quality-adjusted life year (QALY) method, which assesses whether health interventions are good value for money, it should only pay 296,000 francs.

However, Switzerland’s highest court ruled against the insurer.

The court said it had never set an upper limit on liability and stressed in particular that QALY calculations had never been deemed applicable.

In its ruling, the court also said there was no evidence that the treatment in the current case had been more expensive than necessary, and there was therefore no reason why the insurer should not pay.

The Federal Supreme Court said that under current health insurance laws, unlimited liability was guaranteed as long as hospital treatments were effective, targeted and not economically wasteful.

Read also: Swiss Socialists call for health insurance premiums to be capped at 10 percent of income

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HEALTH INSURANCE

Could glasses and contact lenses soon be covered by Swiss health insurance?

The Swiss health system is ranked among the best in the world, but some essentials, like glasses, aren't automatically covered by health insurance. That could soon change, however

Could glasses and contact lenses soon be covered by Swiss health insurance?

Green Party Federal Councillor Katharina Prelicz-Huber revealed in an interview with newspaper 20 Minuten this week that the Federal Parliament had tabled a motion to include prescription glasses and contact lenses in Switzerland’s mandatory health insurance scheme. 

Prelicz-Huber stated: “The purpose of compulsory health insurance is to provide the services you need to get or stay healthy,”

The motion forms part of the legislation that will be voted on during the 2024 summer session of the Federal Council. 

Proposed changes 

According to Switzerland’s peak optician body, 4 in 5 Swiss wear glasses or contact lenses at some point. 

It’s no surprise that statistics repository, Statista, projects the Swiss eyewear industry to be worth €1.37 billion by 2028. 

Currently, glasses and contact lenses are covered for up to 180 francs for children until age eighteen, if they are proscribed by a doctor.

Adults can also claim money back for glasses and contact lenses – however, they must be suffering from one of a short list of specific conditions such as keratoconus – where the cornea is distorted – or severe myopia, otherwise known as near-sightedness.

They must also have been specifically prescribed them by a doctor or optometrist. 

Otherwise, supplemental optical insurance must be purchased in Switzerland to ensure you can recoup the cost. 

Under the Green Party proposal, glasses, contact lenses, and other visual aids would be covered, regardless of age. 

Rising premiums prompt opposition 

Not everybody agrees with the proposal. 

The right-wing SVP has already spoken out against it, with Federal Councillor Diana Gutjahr arguing: “If we seriously want to slow down the burdensome and constantly rising health costs for the benefit of the population, we [must] show the political will not to constantly expand the benefits of compulsory health insurance.”

A spokesman for the the health insurance advocacy group Santesuisse, Matthias Müller, echoed Gutjahr, claiming that insurance constitutes “financing for extraordinary events such as illness.”

“If almost everyone benefits from a certain service, it is no longer an insurance benefit.”

A date for the vote has yet to be announced. 

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