Swiss healthcare minister Alain Berset has announced intentions to save 1 billion CHF for the healthcare system, whilst improving care efficiency.
To achieve this goal, 9 initiatives were proposed on the 19th of August, which are now undergoing public consultation. The following is Centivis’ current understanding based on publicly available documents. However, we acknowledge that the situation may change depending on the results of the public consultation.
3 proposals may be relevant to the diagnostics industry:
1) Cost targets for the Compulsory Health Insurance (OKP): The Federal government may recommend a national cost target for the OKP and cost targets per canton, divided into cost blocks (hospital inpatient, hospital outpatient, ambulatory care, etc.). It is still unconfirmed as to whether cantons can choose to activate measures e.g. tariff cuts to meet the target or if they are obligated to do so.
2) Strengthening the Federal Council’s role in HTA evaluation (WZW evaluation): The Federal Council is proposed to be given authority to decide how and when medical services should be reviewed according to efficacy, appropriateness, and economic benefits (essentially HTA).
Note: HTA evaluation is already in place to allow obsolete or ineffective technologies to be removed from compulsory health insurance coverage.
3) Use of price models and refunds: Based on price models, companies might have to refund insurers a certain amount if prices are too high, if sales exceed a certain volume or if the therapeutic efficacy is not as claimed. While such models are now selectively used, the new initiative proposes to give the Federal Council authority to decide how and when price models will be used and strengthen the legal basis for use of these models. The regulation applies not only to pharmaceuticals but also to all other areas in which price models are used (MiGeL, Analysenliste- which includes IVDs).
These proposed initiatives add to existing cost-cutting efforts. For example, a new law the VITH (Verordnung über die Integrität und Transparenz im Heilmittelbereich) was implemented earlier this year, which requires pharma and medical device manufacturers and service providers to disclose all discounts by documenting them on the invoices and financial records of the purchaser and seller.
Other proposals issued on the 19th of August include compulsory gatekeeping to prevent unnecessary use of specialist services and care coordination efforts where so-called ‘network care coordinators’ will coordinate care for patients (e.g. elderly with multiple chronic diseases treated by multiple specialists) in order to reduce the cost of unnecessary services.
It is important to note that the proposals announced on the 19th of August are still in discussion and lack operational details. Whilst cost-cutting is a strong imperative from the Health Ministry, we understand that existing mechanisms are also in place to control prices in the Analysenliste (main list for IVDs) such as regular BAG and price monitor (Preisüberwacher) reviews [see Schlussbericht pdf p74],
Moving ahead, Centivis will be monitoring these trends and analyzing their impact on the diagnostics industry.