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CSS Insurance

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. Health technology assessments (HTAs) have been developed abroad for this very purpose and their systematic use is now being discussed in Switzerland. In future, the Federal Council intends to step up the systematic review of benefits paid under mandatory healthcare insurance. It is therefore putting the necessary structures in place at the Federal Office of Public Health (FOPH) and providing federal funding in the amount of CHF 10 million. 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.

Like the group of experts appointed by the Federal Council to recommend measures for reining in the rising costs under mandatory healthcare, CSS supports the further establishment of such HTAs. It calls for a transparent process and participation by the key stakeholders, including the health insurers. CSS is therefore involved in the stakeholder-driven Swiss Medical Board through the curafutura association. The Medical Board has been repositioned strategically to enable it to complement the work of the FOPH by assessing urgent and important benefit areas that are of relevance to insured persons in Switzerland. This will allow premium revenues to be better allocated. This realignment is currently being implemented.

You can find further information on the topic of Mandatory services/benefits (HTA) in our publication on health policies "im dialog" 1/2017 (in German).