The parliament shakes the free choice of doctor

The free choice of doctor has so far been considered inviolable in health policy. Suggestions that they wanted to restrict were mashed off by the people and parliament. Most recently, the Managed Care template in 2012 failed. After the Council of States, the National Council has also targeted this naturalness on Thursday. He wants to loosen the contract. The most important questions and answers.

What is the situation at the moment?

In Switzerland, the insured have the free choice of doctor because a contractual forced applies to health insurers. This means that the health insurance companies are generally obliged to recognize all approved service providers. This is considered a cornerstone of the Swiss health system.

However, because there are combinations in some places, while other regions remain under -supplied, the cantons have had additional instruments since 2021 to direct the distribution. You can speak admission restrictions and align hospital planning to the economy and quality of the services. The free choice of doctor was not shaken directly.

How and why should that change now?

A majority of the Health Commission considers the relaxation of the compulsion to contract as necessary due to a quantity and cost explosion in the healthcare system. The supporters complain that the requirements for the quality and profitability of the service providers played a subordinate role. In fact, an approval mainly depends on the training diplomas and the existing infrastructure.

The instruments that Parliament gave the cantons on the hand four years ago did not show the desired effect. The supporters therefore want the health insurance companies to no longer have to recognize all service providers in an oversupply. To do this, they are intended to use the objective criteria on which the cantons are already borne up for the admission restriction.

What speaks against loosening?

A minority of the Health Commission and the Federal Council warn of a fatal shift in power. Instead of the cantons that would act in the sense of public health, profit -oriented insurance would weight the costs more than medical concerns. Interior Minister Elisabeth Baume Schneider says: « This is a paradigm shift. »

The opponents also criticize the time when there is currently a shortage of skilled workers. This sends the wrong signals and, moreover, do not even know whether the additional instruments work. Baume Schneider says: « The additional regulation would only have to have its effect now. »

The reduction in council would rather have discussed degressive tariffs (i.e. falling income with increasing number of treatments per patient), better invoice controls and sanctions in the event of unnecessary treatment.

What do the doctors and cantons say?

The cantons and the FMH and other professional associations have also critically commented – the professional associations even wrote a letter to the National Council. While the cantons fear more bureaucracy and court proceedings, the doctors warn of the disadvantage of seriously ill if the costs form the main criterion.

However, this contradicts an insurance expert who emphasizes to the “Tages-Anzeiger” that most private insurance with all hospitals has contracts, even though they are not subject to a contract. They are aware that the insured people felt more connected to their family doctor than their insurance.

What's next?

With 113 to 72 votes, the National Council has now commissioned the Federal Council to develop a change in the law. As soon as this has happened, the template comes back to parliament. If the national and state council approves the adjustments, the people will probably be on it. The FMH or other health organizations are likely to take the referendum against it.