Go Back   English Forum Switzerland > Help & tips > Family matters/health  
Reply
 
Thread Tools Display Modes
  #1  
Old 21.08.2020, 16:04
Forum Legend
 
Join Date: Sep 2006
Location: na
Posts: 10,893
Groaned at 34 Times in 30 Posts
Thanked 25,545 Times in 7,949 Posts
meloncollie has a reputation beyond reputemeloncollie has a reputation beyond reputemeloncollie has a reputation beyond reputemeloncollie has a reputation beyond reputemeloncollie has a reputation beyond reputemeloncollie has a reputation beyond repute
Basic insurance" Proposed restrictions on free choice of specialists

From SwissInfo (English)

https://www.swissinfo.ch/eng/governm...costs/45977922

and NZZ (German):
https://www.nzz.ch/schweiz/berset-wi...ken-ld.1572126
(May be behind a paywall)


The Bundesrat has proposed new restrictions on free choice of specialists under the basic insurance.

From the SwissInfo article:

The plan foresees that the services of a specialist doctor will only be covered by compulsory health insurance if patients first consult a general practitioner, a telemedicine centre“ or a so-called health maintenance organisation (HMO) which act as gatekeepers.

Berset argued that most patients already follow this practice but that the government wanted to encourage more patients to join.

However, he downplayed concerns about spending caps, saying there was no intention to ration medical services.


---


I'm not sure what I think about this proposal.

I have the traditional model, and am grateful that I can see specialists for on-going treatment on my own if necessary. While I almost always start with the GP, I ended up going to one such on my own because my GP made a pretty glaring misdiagnosis. I pay a higher premium for this model of course.

On the other hand, given that few specialists will see a patient without a referral - regardless of insurance model - we sort of already have this restriction by default.

Will this really bring about the kind of savings projected?

Under these restrictions there would be the cost of two visits rather than one. Or would there? For instance, how does Telemed charge the call for permission to see a doctor?

According to the article 70% already have a managed care model of one type or another.

So what are your thoughts on this proposal?
Reply With Quote
  #2  
Old 21.08.2020, 16:11
st2lemans's Avatar
Forum Legend
 
Join Date: Dec 2010
Location: Lugano
Posts: 31,558
Groaned at 2,347 Times in 1,708 Posts
Thanked 38,350 Times in 18,099 Posts
st2lemans has a reputation beyond reputest2lemans has a reputation beyond reputest2lemans has a reputation beyond reputest2lemans has a reputation beyond reputest2lemans has a reputation beyond reputest2lemans has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

I have family doctor, my wife has normal as her GP is not on the list of accepted family doctors.

I would never go to a specialist without a referral in any case, so don't see the problem, though obviously my wife will go to her gyno without a referal from her GP.

Tom
Reply With Quote
The following 5 users would like to thank st2lemans for this useful post:
  #3  
Old 21.08.2020, 16:43
eyebeebe's Avatar
Forum Veteran
 
Join Date: May 2009
Location: Pfäffikon SZ
Posts: 2,055
Groaned at 17 Times in 16 Posts
Thanked 2,663 Times in 1,146 Posts
eyebeebe has a reputation beyond reputeeyebeebe has a reputation beyond reputeeyebeebe has a reputation beyond reputeeyebeebe has a reputation beyond reputeeyebeebe has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Coming from the UK, the idea of choosing a specialist myself was completely alien.

Generally speaking I‘m in good health, so don‘t need medical treatment very often, but if I do, I wouldn‘t presume to self-diagnose, so seeing a GP who then refers me to a specialist makes sense to me.

The only exception is if I need sports physio and I need to get a referral from the doctor so the health or accident insurance pays for it. And then if it‘s something more serious, I actually trust my physio to refer me to the correct specialist more than a GP.

That said, I have Telmed, as my where I live is different to where I work (Schwyz vs. Zurich) and , so I just call them up and tell them what‘s wrong and they email me a list of people to see, all done in English. It works well for me. There‘s no charge for Telmed calls.
Reply With Quote
The following 4 users would like to thank eyebeebe for this useful post:
  #4  
Old 21.08.2020, 16:49
Island Monkey's Avatar
Forum Legend
 
Join Date: Mar 2008
Location: Wallis
Posts: 5,730
Groaned at 95 Times in 60 Posts
Thanked 6,281 Times in 2,875 Posts
Island Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond reputeIsland Monkey has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

I don’t see a problem for first contact with a specialist... your GP would have more idea the best person to see etc etc. I assume once you’ve had that first referral you’ll be able to go whenever? This is probably to stop people from being like “Oh I have symptom A, I must have condition B, I’ll make an appointment to see Dr C” ..... then finding out they probably have condition Y and should have seen Dr X.
Reply With Quote
The following 2 users would like to thank Island Monkey for this useful post:
  #5  
Old 21.08.2020, 16:56
Forum Legend
 
Join Date: Oct 2014
Location: Nyon
Posts: 4,820
Groaned at 242 Times in 176 Posts
Thanked 6,537 Times in 3,083 Posts
bowlie has a reputation beyond reputebowlie has a reputation beyond reputebowlie has a reputation beyond reputebowlie has a reputation beyond reputebowlie has a reputation beyond reputebowlie has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

It’s been suggested before and faces a long road before it will ever be implemented. Almost certain this would go to the people.

As long as you still have a choice of specialists, rather than being told you can only see their single choice. As an example some of the specialists I have seen are in Geneva and I live in Vaud. It is easier for me to go to Geneva than to Lausanne or Vevey or Payerne.

My Oncologist, in Genolier, was recommended to me by a close friend and he agreed to see me as an exception. My GP is really not that au fait with Cancer and she has been happy for me to chose my specialists.
Reply With Quote
The following 3 users would like to thank bowlie for this useful post:
  #6  
Old 21.08.2020, 17:17
kri's Avatar
kri kri is offline
Forum Veteran
 
Join Date: Nov 2007
Location: Switzerland
Posts: 1,812
Groaned at 18 Times in 17 Posts
Thanked 1,551 Times in 801 Posts
kri has a reputation beyond reputekri has a reputation beyond reputekri has a reputation beyond reputekri has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

I don't understand the intent - the different models exit and provide discounts etc.

Why would we eliminate the model if some people are willing to pay more to use it? I cannot imagine scenarios where people just tour specialists anyway so not clear of what issue we are trying to solve with this proposal.
Reply With Quote
The following 4 users would like to thank kri for this useful post:
  #7  
Old 21.08.2020, 17:22
Member
 
Join Date: Feb 2018
Location: Zürich
Posts: 169
Groaned at 3 Times in 3 Posts
Thanked 138 Times in 72 Posts
rezak has earned some respectrezak has earned some respect
Re: Basic insurance" Proposed restrictions on free choice of specialists

I have telmed and to be honest I never felt any disadvantage w.r.t. the traditional model beside the bureaucracy: the discount I receive is for taking 5 min of my time to make a call before every visit (in my personal experience).

If I have some problem and I know that I want to go to the specialist (because, for example, they followed me for the same problem 1 year ago) - I call telmed, when the robot asks me if I need consultation I say no, then they pass an operator and I say "I have X problem, I want to go to specialist Y next week", and their response is only "cool, thanks for calling".
Sometimes it goes as flexible as "I need to go to <specialist type>" - "do you know already who?" - "did not choose yet" - "do you know when?" - "not yet" - "ok, I opened a window for 30 days for this type of specialist, cheers".
Reply With Quote
The following 3 users would like to thank rezak for this useful post:
  #8  
Old 21.08.2020, 17:29
fatmanfilms's Avatar
The Marmite Moderator
 
Join Date: Apr 2010
Location: Verbier
Posts: 20,896
Groaned at 445 Times in 339 Posts
Thanked 22,041 Times in 11,454 Posts
fatmanfilms has a reputation beyond reputefatmanfilms has a reputation beyond reputefatmanfilms has a reputation beyond reputefatmanfilms has a reputation beyond reputefatmanfilms has a reputation beyond reputefatmanfilms has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

I had HMO model & the only time I saw a specialist it was at a major eye hospital in a different canton. I told my Dr after the event, he was quite happy, I continued treatment for 8 years even after changing insurer & nobody ever batted an eyelid. I needed a blood test whilst working in another canton & just went to the nearest Dr, no issue at all.
Reply With Quote
  #9  
Old 21.08.2020, 17:34
Belgianmum's Avatar
Forum Legend
 
Join Date: Jan 2010
Location: Neuchâtel
Posts: 13,025
Groaned at 221 Times in 188 Posts
Thanked 21,495 Times in 8,810 Posts
Belgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Quote:
View Post
I cannot imagine scenarios where people just tour specialists anyway so not clear of what issue we are trying to solve with this proposal.
Oh you’d be surprised, plenty of people do just that.
Reply With Quote
The following 3 users would like to thank Belgianmum for this useful post:
  #10  
Old 21.08.2020, 18:46
Forum Veteran
 
Join Date: Jan 2014
Location: Lausanne
Posts: 540
Groaned at 44 Times in 25 Posts
Thanked 579 Times in 320 Posts
dandi has an excellent reputationdandi has an excellent reputationdandi has an excellent reputationdandi has an excellent reputation
Re: Basic insurance" Proposed restrictions on free choice of specialists

Saw this too and to be honest I fail to see the reason why this would bring in any savings with the current system - as opposed to many other measures that could be taken but nobody has the political balls to take them.

As others said before - I would think most people do actually check with their GP first - and do see the specialist after. It means that there are two consultations being charged in the end - why would this be cheaper than just one consultation with the specialist? Is this because the specialist may be charging more? Does anyone realistically think that passing by the GP first would make the specialist charge less?

At the end of the day, specialists have to charge within TARMED, so it whether you choose the doctor or not, why should there be differences for the same treatment at different specialists? Unless we are talking a reduction in service?

And finally, by moving everyone to "HMO" type systems, it means people should be paying less to the insurance - again, where is the saving?

My suspicion here is that this will be played long-term, and several things can happen:
- moving everyone to HMO system will give an excuse to increase prices to the HMO model even further - that means increase for over 70% of the current insured base
- forcing out customers from smaller "liberal" doctors/clinics/cabinets towards the big "healthcare" business that we all know how work - massive efficiency drives with savings in personnel, materials and services and big cheques for the top management

If they really wanted to reduce the insurance costs down, they could just make sure you don't pay 10 francs for a pack of paracetamol but more like the 1-2 francs that it actually costs
Reply With Quote
The following 4 users would like to thank dandi for this useful post:
  #11  
Old 21.08.2020, 18:57
Forum Veteran
 
Join Date: Jul 2020
Location: Up there over the fog
Posts: 1,914
Groaned at 257 Times in 189 Posts
Thanked 2,108 Times in 1,040 Posts
JackieH has a reputation beyond reputeJackieH has a reputation beyond reputeJackieH has a reputation beyond reputeJackieH has a reputation beyond reputeJackieH has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Yep- until they get one who tell them what they want to hear and give them the drugs or treament they have 'researched' on t'internet. It is hugely costly to the system- and to some extent, dangerous too.


Our GP is French and works as an all-rounder- like most UK GPs- she and us, do not see the point or the advantage of seeing a pediatrician for kids with common colds, etc- nor for using a gyneacologist for basic examinations and smears, etc - again, hugely expensive and just not necessary.
Reply With Quote
This user would like to thank JackieH for this useful post:
  #12  
Old 21.08.2020, 21:12
Forum Veteran
 
Join Date: Jul 2020
Location: Frick, Aargau
Posts: 2,493
Groaned at 50 Times in 44 Posts
Thanked 3,365 Times in 1,622 Posts
HickvonFrick has a reputation beyond reputeHickvonFrick has a reputation beyond reputeHickvonFrick has a reputation beyond reputeHickvonFrick has a reputation beyond reputeHickvonFrick has a reputation beyond reputeHickvonFrick has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Quote:
View Post
Yep- until they get one who tell them what they want to hear and give them the drugs or treament they have 'researched' on t'internet. It is hugely costly to the system- and to some extent, dangerous too.


Our GP is French and works as an all-rounder- like most UK GPs- she and us, do not see the point or the advantage of seeing a pediatrician for kids with common colds, etc- nor for using a gyneacologist for basic examinations and smears, etc - again, hugely expensive and just not necessary.
There are those of us who have chronic conditions (in my case dermatological), who are very poorly served by GPs though.

For my condition, GPs don't tend to have much understanding, tend to massively under-medicate and overstate the risks of the medication.

I have eczema that can flare up quite badly and several different GPs repeatedly tried to get me to use hydrocortisone (a mild steroid) that is totally inappropriate for the extent of my inflammation - the specialist took one look at me and prescribed a potent steroid (mometasone), and tacrolimus (an immunosuppressant). I had specially asked GPs for tacrolimus and they said it wasn't appropriate.

After years of having a chronic condition you do end up knowing more than the GPs - I don't see any value in using them for my condition.

Back in the UK I had to go through a GP each time I wanted to see the dermatologist. That's a complete waste of everybody's time. There needs to be a button that can be pressed saying "chronic condition - let them visit the specialist in X area at will".

Maybe there is in CH - I haven't needed to go yet as I brought a big stack of medicine over from the uk.
Reply With Quote
The following 3 users would like to thank HickvonFrick for this useful post:
  #13  
Old 21.08.2020, 21:30
kri's Avatar
kri kri is offline
Forum Veteran
 
Join Date: Nov 2007
Location: Switzerland
Posts: 1,812
Groaned at 18 Times in 17 Posts
Thanked 1,551 Times in 801 Posts
kri has a reputation beyond reputekri has a reputation beyond reputekri has a reputation beyond reputekri has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Quote:
View Post
Yep- until they get one who tell them what they want to hear and give them the drugs or treament they have 'researched' on t'internet. It is hugely costly to the system- and to some extent, dangerous too.


Our GP is French and works as an all-rounder- like most UK GPs- she and us, do not see the point or the advantage of seeing a pediatrician for kids with common colds, etc- nor for using a gyneacologist for basic examinations and smears, etc - again, hugely expensive and just not necessary.
Does your doctor charge you less for those things than a pediatrician or a gynecologist would? Given the Farmed I would assume all pretty similar right?
Reply With Quote
This user would like to thank kri for this useful post:
  #14  
Old 22.08.2020, 10:37
Belgianmum's Avatar
Forum Legend
 
Join Date: Jan 2010
Location: Neuchâtel
Posts: 13,025
Groaned at 221 Times in 188 Posts
Thanked 21,495 Times in 8,810 Posts
Belgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Quote:
View Post
Does your doctor charge you less for those things than a pediatrician or a gynecologist would? Given the Farmed I would assume all pretty similar right?
No they don’t, the system here is different from the UK so you can’t really make comparisons like that.
The cost will be the same wherever you go.

Practice based paediatricians here are basically just GPs for children, whether you take a child to the GP or the paediatrician for a vaccine or a cold or whatever will make no difference whatsoever. The paediatrician is just more used to dealing with children and childhood illnesses as they are seeing them on a day to day basis. More complex issues will be referred to the specialist paediatricians.

It’s pretty much the same for the gynaecologist, the practice based ones are just like GPs dealing with women’s issues. Complex stuff will be referred to specialist gynaecologists.


Given that paediatricians, gynaecologists and ophthalmologists are all exempt from the obligation to pass via a GP, telmed or HMO service irrespective of insurance model it isn’t really relevant to this discussion anyway.

Last edited by Belgianmum; 22.08.2020 at 13:53. Reason: Typos
Reply With Quote
The following 7 users would like to thank Belgianmum for this useful post:
  #15  
Old 22.08.2020, 14:48
Forum Veteran
 
Join Date: Jul 2020
Location: Up there over the fog
Posts: 1,914
Groaned at 257 Times in 189 Posts
Thanked 2,108 Times in 1,040 Posts
JackieH has a reputation beyond reputeJackieH has a reputation beyond reputeJackieH has a reputation beyond reputeJackieH has a reputation beyond reputeJackieH has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Agreed, financially. Some of us prefer the idea of a GP who has a through overview of any patient, their treatment and medication, etc - rather than separate bits of pieces- in a more holistic way- and where specialists are used for more complex and specialised issues- but still with the GP fully in the picture - and yes, it does keep costs down, and numerous other interventions and tests.
Reply With Quote
  #16  
Old 22.08.2020, 18:22
smb smb is offline
Junior Member
 
Join Date: May 2016
Location: ZH
Posts: 51
Groaned at 5 Times in 1 Post
Thanked 42 Times in 24 Posts
smb has earned some respectsmb has earned some respect
Re: Basic insurance" Proposed restrictions on free choice of specialists

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.
Reply With Quote
This user would like to thank smb for this useful post:
  #17  
Old 22.08.2020, 18:40
Belgianmum's Avatar
Forum Legend
 
Join Date: Jan 2010
Location: Neuchâtel
Posts: 13,025
Groaned at 221 Times in 188 Posts
Thanked 21,495 Times in 8,810 Posts
Belgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond reputeBelgianmum has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Quote:
View Post
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.
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.
Reply With Quote
The following 2 users would like to thank Belgianmum for this useful post:
  #18  
Old 22.08.2020, 18:41
Forum Legend
 
Join Date: Oct 2014
Location: Nyon
Posts: 4,820
Groaned at 242 Times in 176 Posts
Thanked 6,537 Times in 3,083 Posts
bowlie has a reputation beyond reputebowlie has a reputation beyond reputebowlie has a reputation beyond reputebowlie has a reputation beyond reputebowlie has a reputation beyond reputebowlie has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

If they really want to save money they could do an audit of what some of these specialists are charging the insurance companies.

I went to the dermatologist a couple of weeks back for him to check on some of the moles that he had frozen off in a previous session.

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 called the insurance company which said unless I wanted to submit a formal complaint they wouldn’t do anything as the billing was within norms.

I like this Dr but I don’t like the billing his office does. My Oncologist’s office also inflates their bills.
Reply With Quote
  #19  
Old 22.08.2020, 18:54
Member
 
Join Date: Jul 2019
Location: Zurich
Posts: 175
Groaned at 11 Times in 8 Posts
Thanked 421 Times in 126 Posts
GParker has a reputation beyond reputeGParker has a reputation beyond reputeGParker has a reputation beyond reputeGParker has a reputation beyond reputeGParker has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

It seems fair to me that the insurer has some say in how you spend their money. If you’re not a doctor, it seems obvious you need to see one first before referring yourself to a specialist no?
Reply With Quote
The following 2 users would like to thank GParker for this useful post:
  #20  
Old 22.08.2020, 19:22
curley's Avatar
Forum Legend
 
Join Date: Oct 2006
Location: canton ZH
Posts: 12,593
Groaned at 206 Times in 171 Posts
Thanked 14,389 Times in 7,438 Posts
curley has a reputation beyond reputecurley has a reputation beyond reputecurley has a reputation beyond reputecurley has a reputation beyond reputecurley has a reputation beyond reputecurley has a reputation beyond repute
Re: Basic insurance" Proposed restrictions on free choice of specialists

Quote:
View Post
I have family doctor, my wife has normal as her GP is not on the list of accepted family doctors.

I would never go to a specialist without a referral in any case, so don't see the problem, though obviously my wife will go to her gyno without a referal from her GP.

Tom
Same here. Wouldn't see a specialist without reference. Took me a while that this behaviour of mine gave me the chance for a discount.

The gyno and the ophthalmologist are always exempt, by the way. Free choice there always, even re canton. I have both of mine in Zurich - no matter which canton/city I ever lived, I see "mine".
Reply With Quote
Reply




Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Proposed restrictions in lump sum pension withdrawal Phil_MCR Finance/banking/taxation 5 17.06.2017 16:09
Free - Free - Bertlitz language pack - New Basic German Traubert Free stuff 4 08.04.2017 09:47
Basic Insurance: Proposed Evaluation of Currently Covered Treatments meloncollie Swiss politics/news 12 06.05.2016 13:31
[proposed] new health insurance system simple_person Insurance 95 01.10.2014 23:03
[UK news] Proposed "Fat tax" Lob International affairs/politics 27 25.04.2009 14:51


All times are GMT +2. The time now is 01:17.


Powered by vBulletin® Version 3.8.4
Copyright ©2000 - 2021, Jelsoft Enterprises Ltd.
LinkBacks Enabled by vBSEO 3.1.0