What is Sympany doing to counter rising health costs?
Each year, Sympany verifies hundreds of thousands of invoices from service providers such as hospitals, doctors, pharmacies and therapists. Amongst other things, it checks whether charges are being applied correctly, whether statements are correct and whether the treatments listed are effective, expedient and cost-efficient as the law requires. Verifying invoices enables us to identify and object to any incorrect or even fraudulent invoices.
Invoice verification prevents unjustified payments, thereby making an important contribution to curbing rising costs. Industry association santésuisse estimates that this verification process carried out by health insurance companies yields savings of nearly 5% on premiums for policyholders. This amounts to somewhere between CHF 2,000 and 3,000 per policyholder each year.
There are many instances where it is unclear or disputed whether the treatment costs must or can be assumed by basic health insurance. Like all other health insurance companies, Sympany is supported in this assessment by a medical examiner.
The charges applied in the healthcare system are the result of regular collective bargaining between health insurance companies and the service providers such as doctors and hospitals. In its negotiations with the service providers, Sympany is committed to ensuring that services are provided efficiently and that charges and prices for treatments represent value for money.
What happens if tariff negotiations fail?
The demands of both parties can differ greatly in policy negotiations. However, the health insurance companies and service providers work hard to find a mutually acceptable solution. If negotiations are not successful, a policy cannot be issued. For policyholders, this means Sympany only pays the highest tariffs it has set for treatment. Costs which are not covered must be paid by the policy holder. If this is the case, we will of course contact the customers concerned to try and find a solution.
As a fair health insurer, Sympany believes in the importance of offering affordable premiums. Which is why Sympany is testing the new option of a voluntary reduction of reserves, which was created by the Federal Council in 2021. This enables us to give unnecessary reserves back to our basic insurance customers. This reduction of reserves therefore benefits you in the form of lower premiums.
Surpluses arise if the cost of medical treatment ends up being lower than anticipated when setting premiums. As a fair insurance company, Sympany reimburses this money to its customers. Starting in 2022, surplus payments are now only permitted for supplementary insurance. They are no longer permitted for basic insurance, or only in exceptional cases.
Sympany is committed to high-quality, low-cost basic healthcare. With this aim in mind, Sympany founded the company Meconex, which opened an HMO centre in Basel back in 1991. Today, there is a national network of group practices and healthcare centres under the name centramed with the focus on integrated care.
The innovative casamed pharm pharmacy model also offers cost-effective and professional primary care. Under this scheme, policyholders can obtain medical advice at a Sympany partner pharmacy or by telephone around the clock and without having to wait.
Managed Care models generate cost savings of between 10 to 15%.
As a health insurer, Sympany concentrates on being a fair and reliable insurance partner for its customers. We therefore approach further health-related activities within a defined framework. For example, Sympany supports its customers by contributing generously to preventive measures in keeping with the principle of “Getting fit” (recognised health-promoting courses such as smoking cessation, back training, nutritional advice) and “Staying fit” (gyms, sports clubs, sports associations).
Sympany sets great store by keeping its administrative costs low. In recent years, the company has succeeded in becoming even more operationally efficient by introducing innovations such as automated processing and new IT systems. The march of digitalisation is also bringing efficiency improvements and helping to save on paper and postage costs, among other things.
Sympany uses its resources wisely and in moderation. This is particularly true of our communication measures, which are financed mainly with funds from supplementary insurance that is voluntary for policyholders.
With the Sympany app and its handy photo function, you can easily send us your invoices at any time, postage-free. The premium calculator on the Sympany website lets you calculate your premium and take out your health insurance policy online. Our customer portal will also be available to you from 2018, providing another way to get easy and paperless access to various services around the clock.
Invoices are exchanged with service providers efficiently by digital means wherever possible.