Cost targets and cost containment measures

Per capita healthcare costs continue to rise at rates that by far outstrip the cost of living and wage growth. As a result, an increasing number of insured persons find themselves struggling to pay their monthly premiums. At the same time, many cantons are increasingly withdrawing from the premium reduction system in an attempt to make savings.

That is why CSS Insurance welcomes the now intense discussion, first launched back in 2017, on suitable measures for reining in costs within the mandatory healthcare insurance (OKP) system. It actively supports the implementation of measures from the report produced by the group of experts appointed by the Federal Council to recommend action on the subject as well most of the measures in the packages proposed by the Federal Council itself on the basis of that report.

Binding targets must be set for OKP growth in order to keep future cost growth in check and make it measurable in qualitative terms. These would serve as benchmarks for all future cost containment measures, thus making the latter both measurable and manageable. In addition, targets of this kind would strengthen the tariff partnership by increasing the pressure on tariff partners to enter into agreements that place greater emphasis on cost-effectiveness, thus reining in cost growth. The tariff partners have failed in their negotiations to bring costs under control, despite repeated statements of intent to the contrary. The current operating conditions and tariffs can do nothing to stem volume growth and therefore cost growth. Binding targets would also force the authorities to fully live up to their responsibility and statutory remit to act in favour of the insured persons when it comes to HTAs or administered prices, for example.

The cost targets are part of the Federal Council’s second package of measures. CSS welcomes the provisions on cost targets. The Federal Council's proposal for implementation is relatively pragmatic and largely consistent with CSS's position. All of the actors – including the federal government (administered prices, aids and appliances list, medication) and the tariff partners – will be required to stick to these targets in future and use them as a benchmark against which to measure the success of any action they take. Cost growth should be evidence-based (following the logic of the effectiveness, appropriateness and cost-effectiveness criteria plus population growth). The introduction of binding cost targets along with measures for putting them into practice calls for open-ended discussions and active stakeholder involvement. The provisions seeking to guarantee the insured persons' entitlement to cost coverage of the insured benefits and proposing that the impact of the cost targets on the development of costs and quality be regularly reviewed are both important and correct. They ensure that the quality and supply of services will be maintained.