Mandatory services / benefits (HTA)

CSS is of the opinion that rigorous management of the service/benefit catalogue using benefit and quality criteria is both necessary and makes sense. Existing and new services should be examined in terms of their effectiveness, appropriateness and cost-effectiveness ('WZW criteria') by an independent body applying standardised and transparent procedures. All services that fail to satisfy the WZW criteria should be excluded from the service catalogue. The Federal Council wishes to strengthen the systematic review of services that are reimbursed under mandatory healthcare insurance and has created structures for systematic health technology assessments (HTAs) within the FOPH. Optimal implementation of HTAs will enable the OKP service and benefit catalogue to be managed in such a way that an assessment of the WZW criteria is noted for its uniform, systematic, transparent, scientific and evidence-based approach. When making a decision, the competent authorities will be unable to ignore corresponding recommendations without stating sufficient reasons. This will also promote transparency in the decision-making process.

CSS fundamentally supports the development of such HTAs. It calls for a transparent process and participation by the key stakeholders, including the health insurers. The FOPH's HTA processes have potential for optimisation, as noted in a May 2020 report by the Federal Finance Committee. CSS now expects to see timely improvements in the processes at federal level, followed shortly by effective results.