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Old 21.08.2020, 16:04
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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?
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Old 21.08.2020, 16:11
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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
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Old 21.08.2020, 16:43
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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.
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Old 21.08.2020, 16:49
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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.
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Old 21.08.2020, 16:56
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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.
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Old 21.08.2020, 17:17
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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.
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Old 21.08.2020, 17:34
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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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.
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Old 21.08.2020, 17:22
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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".
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Old 21.08.2020, 17:29
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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.
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Old 22.08.2020, 19:22
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Re: Basic insurance" Proposed restrictions on free choice of specialists

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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".
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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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Old 22.08.2020, 18:22
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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.
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Old 22.08.2020, 18:40
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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.
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.
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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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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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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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Old 22.08.2020, 18:41
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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.
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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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Old 22.08.2020, 18:54
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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?
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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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