Hi everybody,

have been spending some hours now trying to understand the different models for the basic health insurance (i.e. standard, callMed, careMed, netMed).

The insurance companies seem to offer a 10-20% discount when choosing the GP or HMO models. You are then required to see them first and they would refer you to a specialist if necessary. I am aware of the exceptions like gynecologist or ophthalmologist.

My question is: do I have to pay for the consultation in the GP/HMO practice? Or maybe the other way around: I don't pay at the specialist's if I show the "Überweisung" from the GP (like in the German system)?

If I have to pay twice (once for the GP and once for the specialist), then this variant can prove even more costly then the standard one...

And what would you advice me between the two? I live in Zürich, so there should be a good offer on HMOs...

Many thanks for any comments or advices.

Cristina

An interesting question. I actually have the HMO model since this year, but never used it until now. In fact, I might call them tomorrow to ask them.
If I don't forget it.
The "advantage" of the model is that you pay less but can't do "doctor hopping".
I prevents people from seeing multiple doctors for the same illness.
I work in Wiedikon, where SWICA's HMO-center is also located.
So it's not a big problem for me. And I rarely actually have to see a doctor.

Last year, a lot of people changed into these models, so this year the insurance companies had to raise the monthly contributions. I'm sure you got your letter from the health insurance already.
The problem is: health-care is not like meat, where people really eat less when it's more expensive.
While there's the cliche of old people just going to the doctor to have a chat in the waiting room and get to talk to the doctor, the amount spent on this kind of treatment is not significant compared to what e.g. a myocardial infarction and the treatment in the months afterwards ends up costing (50-100k).
I pay 200 per month, the otitis media last year ended up costing some 500 or 700 CHF (including going to the emergency at 02:00 at the weekend and a couple of examinations in the weeks after), which I paid from my franchise.

Switzerland sees some 30000 myocardial infarctions every year, according to this site: http://www.swissheart.ch/index.php?id=1295
and is expected to spend almost 70 billions in 2012 on healthcare-costs:
http://www.drs.ch/www/de/drs/nachric...ger-stark.html
Politicians already count it as a success when the increase in costs is not "dramatic" two years in a row.

For you, the gain is financial. Also, if you have a GP that you like and trust, then that makes it easy. We have the classic model with a telemedicine option - we basically call them to tell them when we have an appointment. It's really non invasive, and that saves us money too.

Truth be told, we see our GP before we see almost anyone else, because our GP is a great referral source. My GP is actually an internist, and most of what we've needed has been accomplished by our own doctor. Not sure how the GP/HMO model works differently, I assume you do pay to see your GP. In more than three years, only my husband has needed to see a specialist once.

It also depends on what you need. My husband and I have some chronic conditions requiring followup, so internal medicine is good for us, personally.

Do they have lower rates? Or u just mean here the discounts in the premiums?

Yeah, I also was thinking of getting an internist. One that works as a GP in a HMO. )