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  #21  
Old 22.08.2020, 19:34
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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I was in and out in less than 10 minutes but the bill he sent to the insurance company was for 30 minutes (5 plus 5 plus 15 plus 5) of consultations and for 15 minutes reviewing my file before I arrived.
I had a GP many years ago (not in CH), and during what i assumed was small talk before the start of the consutation, she asked if I had been on vacation and I said I had. She asked how it had been and I said it had been good mostly but I'd had a light touch of indigestion, presumably from eating some salad that hadn't been washed properly, but fortunately the problem had gone away within a day and I'd been fine after that. She said, when you visit countries like that you shouldn't eat salad.

The actual consultation was about something completely unconnected.

When the bill came there was an item labelled "nutritional advice".

The moral of the story is,don't tell doctors anything they strictly don't need to know, not even in what you think is smalltalk.
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  #22  
Old 22.08.2020, 19:43
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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I'm strongly against this proposal offered by Alain Berset.

I think, instead of this solution it would be more correct if people paid to alternative medicine specialists out of their own pocket, as they pay to gynecologists and ophthalmologists (I know that this proposal was once rejected).

And I also think, it would be better if the patients would be allowed to review the invoices before insurance companies pay them, because insurance companies don't know what has been done to a patient, how long a patient was in a doctor's room and so on, and some doctors use this. I always try to get the invoice and to check it, but usually it's difficult to get it from a doctor.
All fine and good, and maybe you will find an error, but do you really know how to assess an invoice from a physician‘s office. I don‘t.

I never pay out of pocket for the gyn or ophthalmologist unless I’ve not met my franchise or it‘s the 10% excess or it‘s not covered under general insurance.

I have the non binding telmed model. I have to call in any new event. It‘s totally easy, I’ve had no issues and they give good info if needed.
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  #23  
Old 22.08.2020, 20:58
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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Why do you say people pay for ophthalmologists and gynaecologists from their own pockets? The insurance reimbursed me for mine.
You can always get a copy of the invoice from the insurance company.
That's my mistake, I had to write "dentists" instead of "ophthalmologists". But glasses are not covered anyway. Gynaecological check-ups (including breast examination) are covered only once in three years.

When I asked my insurance company to send me a copy of an invoice, because the doctor forgot to send it to me, I was told that they could send it as an exception, "but the next time ask the doctor for it".

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All fine and good, and maybe you will find an error, but do you really know how to assess an invoice from a physician‘s office. I don‘t.
I think if the doctor wrote "kleine Untersuchung" and you were only talking to her, it's possible to notice a mistake. Just an example.
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  #24  
Old 23.08.2020, 12:13
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Re: Basic insurance" Proposed restrictions on free choice of specialists

I have an uncommon disease and it took me doctor shopping and almost 8 years to get it diagnosed. If I didn't have free choice of specialists, I would have never gotten my diagnosis and treatment sorted. My family doctors had always just wanted to prescribe an antidepressant.

This system terrifies me and most us with more rare conditions.
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  #25  
Old 23.08.2020, 12:17
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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I'm strongly against this proposal offered by Alain Berset.

I think, instead of this solution it would be more correct if people paid to alternative medicine specialists out of their own pocket, as they pay to gynecologists and ophthalmologists (I know that this proposal was once rejected).
I have never had to paid to see a gynecologist out of pocket. What is this about?
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  #26  
Old 23.08.2020, 18:58
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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...Gynaecological check-ups (including breast examination) are covered only once in three years...
I think that's the standard line you're given in the insurance paperwork. However in my experience, even on basic insurance, if the doctor says you need to be seen to monitor a condition every 6 months or whatever, insurance pays. I've never had them refuse. I've only had to pay franchise/co-pay.
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  #27  
Old 23.08.2020, 20:08
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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I think that's the standard line you're given in the insurance paperwork. However in my experience, even on basic insurance, if the doctor says you need to be seen to monitor a condition every 6 months or whatever, insurance pays. I've never had them refuse. I've only had to pay franchise/co-pay.
Same for me, I’ve never had to pay for a gynaecologist appointment and I have a full check up annually.
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  #28  
Old 24.08.2020, 14:01
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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Same for me, I’ve never had to pay for a gynaecologist appointment and I have a full check up annually.
I asked a friend and apparently, this has to do with how "healthy" you are. Anything that places you at risk gets you an annual check-up.
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  #29  
Old 24.08.2020, 17:18
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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Same for me, I’ve never had to pay for a gynaecologist appointment and I have a full check up annually.
I have a friend who does have a medical condition that requires multiple check ups a years with the gyno, and she has to pay out of pocket for each visit plus surgeries (for a rare disorder).
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  #30  
Old 24.08.2020, 17:59
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Re: Basic insurance" Proposed restrictions on free choice of specialists

It seems that the intent is a further push on GP. Increase the quality of diagnosis and the subsequent referrals.

Just pick a kickass GP and have no problems following his plan of treatment, whether it involves specialists or not.

Seems also the insurers have accumulated expensive claims due to messed up diagnosis, not only that people flood specialists' offices maybe due to not bothering with GP's view. Clients have grown assertive, normal when there is a choice between good and bad GPs.
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  #31  
Old 24.08.2020, 23:13
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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The Bundesrat has proposed new restrictions on free choice of specialists under the basic insurance.
This will never fly, it was dead in the water even before its invention.

What should be done, and would have a chance to pass IMO, is give the mandatory insurances the option to refuse to pay the bills from a few docs who they suspect of overtreating. Would need to be checked with BAG beforehand of course, and only a relatively few. As things stand there's basically no risk for the docs.
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It seems that the intent is a further push on GP. Increase the quality of diagnosis and the subsequent referrals.

Just pick a kickass GP and have no problems following his plan of treatment, whether it involves specialists or not.

Seems also the insurers have accumulated expensive claims due to messed up diagnosis, not only that people flood specialists' offices maybe due to not bothering with GP's view. Clients have grown assertive, normal when there is a choice between good and bad GPs.
The Swiss medical system needs to introduce measures that work as incentives to improve quality and effectiveness. There's no such thing today, errors are almost impossible to prove for the patient, thus nothing improves.

The debacle around Covid data is one such consequence. Data transfer still happens manually with all the usual consequences (slow, high error rate, and expensive). But nobody has to bear the consequences thus everybody involved keeps fighting everybody else.
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  #32  
Old 24.08.2020, 23:32
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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Just pick a kickass GP
And therein lies a problem, as I see it.

In my area, there is a shortage of GPs that is only likely to get worse in the coming years. Picking a GP is often a matter of searching high and low for someone, anyone, willing to take on new patients. While I'd love to find that holy grail, a kickass GP, given the shortage I'll settle for a diploma and a pulse.

I am on my fourth GP in 10 years. The first three each retired, and my current GP has just announced that she is going to part time, working only one or two days per week. That means it will get harder to schedule appointments.

If this proposal means more work for the GP at the same time GP availability is decreasing, that's a worrying out trade.

So... Telemed?
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  #33  
Old 25.08.2020, 00:02
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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What should be done, and would have a chance to pass IMO, is give the mandatory insurances the option to refuse to pay the bills from a few docs who they suspect of overtreating.
Insurances can already do that, but probably given the effort involved they don't find it too much worthwile - they just load up the bill to the state.

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The Swiss medical system needs to introduce measures that work as incentives to improve quality and effectiveness. There's no such thing today, errors are almost impossible to prove for the patient, thus nothing improves.
Exactly. Nobody in the system - except the state - have any incentive to save. Not even the insurances - they just increase the prices, turnover, and their bill to the state. And GPs/doctors/specialists/etc have absolutely 0 incentive to be more efficient, when they are the ones that pocket the bills.
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  #34  
Old 25.08.2020, 04:13
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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Insurances can already do that
This claim requires solid evidence.

Perhaps search for "Vertragszwang für Krankenkassen" while you're at it.
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Nobody in the system - except the state - have any incentive to save. Not even the insurances - they just increase the prices, turnover, and their bill to the state.
That part I disagree with, the patients have the option to switch, and many do. However that's just cost optimisation, rather than quality (which should at least be equally important).
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  #35  
Old 26.08.2020, 15:19
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Re: Basic insurance" Proposed restrictions on free choice of specialists

I'm diabetic and have fairly regular checkups, about every 4 months. For many years I was on the telmed system and so had to give them a call before every consultation. I just got fed up with being asked the same totally irrelevant questions each time (no I don't have an in-grown toenail, type of thing), so I dropped it and just pay my 30 CHF per month extra.
The telmed calls brought no additional value, either to me or to the insurance company. Indeed, they must have just cost the insurance company money each time. I don't see how you can apply this model to people who have a chronic condition and need regular treatment.
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  #36  
Old 26.08.2020, 15:46
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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And therein lies a problem, as I see it.

In my area, there is a shortage of GPs that is only likely to get worse in the coming years. Picking a GP is often a matter of searching high and low for someone, anyone, willing to take on new patients. While I'd love to find that holy grail, a kickass GP, given the shortage I'll settle for a diploma and a pulse.



If this proposal means more work for the GP at the same time GP availability is decreasing, that's a worrying out trade.
That is indeed the problem. Becoming a GP is not attractive to most doctors so as the older ones retire there is nobody to replace them.
Finding a good GP is indeed very difficult and often there isn’t a choice as the good ones are not taking new patients.

We are very lucky as we have a fabulous GP who took over from our old one when he retired. She is young so hopefully she’ll be around for a long time.
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  #37  
Old 26.08.2020, 16:40
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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I'm diabetic and have fairly regular checkups, about every 4 months. For many years I was on the telmed system and so had to give them a call before every consultation. I just got fed up with being asked the same totally irrelevant questions each time (no I don't have an in-grown toenail, type of thing), so I dropped it and just pay my 30 CHF per month extra.
The telmed calls brought no additional value, either to me or to the insurance company. Indeed, they must have just cost the insurance company money each time. I don't see how you can apply this model to people who have a chronic condition and need regular treatment.
I also have telmed - the non binding kind. But for any chronic issues such as cancer or diabetes, if you call at the beginning of the year, for the same doctor, you don‘t have to call again within that year îf it is the same issue. I‘ve had telmed as long as we‘ve lived in CH (13 years) and had one problem about 7 years ago when we had viva care (visana). More of an unpleasant interaction on the phone about notifying them. We switched to SWICA the next year and they‘ve been fine.
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