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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. 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 supports the development 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 aim is to join with santésuisse and the MTK association in making more use of the Medical Board as a platform for clarifying key disputed services and benefits from the insurers’ viewpoint.

You can find further information on the topic of mandatory services and HTAs in our publication on health policies "im dialog" 1/2017 and 1/2018 (in German).