Inter­pel­la­ti­on Lohr (22.3998): Digi­tizati­on and cost con­tain­ment in man­da­to­ry health insurance

Inter­pel­la­ti­on Lohr (22.3998): Digi­tizati­on and cost con­tain­ment in man­da­to­ry health insurance

Sub­mit­ted text

Sin­ce its intro­duc­tion in 1996, the man­da­to­ry health care insu­rance (OKP) has offe­red a legal­ly pre­scri­bed cata­log of bene­fits that is the same for all health insu­rance com­pa­nies. The OKP is thus one and the same pro­duct offe­red by dif­fe­rent health insu­r­ers. Howe­ver, alt­hough the bene­fits in the man­da­to­ry basic insu­rance are the same ever­y­whe­re, the­re are signi­fi­cant dif­fe­ren­ces in admi­ni­stra­ti­ve costs. In 2019, the Fede­ral Office of Public Health (FOPH) regi­stered 51 health insu­rance com­pa­nies in the OKP sec­tor. The admi­ni­stra­ti­ve costs per per­son varied bet­ween CHF 99 and CHF 573. This offers gre­at poten­ti­al for cost con­tain­ment wit­hout inter­fe­ring with health-rela­ted ser­vices. The Digi­tizati­on of the OKP accoun­ting system can bring con­cre­te bene­fits here and lead to mas­si­ve savings.

The­r­e­fo­re, I come to the Fede­ral Coun­cil with the fol­lo­wing questions:

1) What is the Fede­ral Council’s posi­ti­on on the goal of exploi­ting an annu­al savings poten­ti­al of seve­ral hundred mil­li­on Swiss francs by opti­mi­zing the busi­ness and tech­ni­cal pro­ce­s­ses in the OKP accoun­ting system through modern digitization?

2. could this be achie­ved by a Out­sour­cing of the OPK accoun­ting system to a modern cloud ser­vice take place?

3. does the Fede­ral Coun­cil agree that such a mea­su­re would lead to grea­ter trans­pa­ren­cy and efficiency?


Health insu­rance pre­mi­ums are rising shar­ply again this year. The popu­la­ti­on is also suf­fe­ring from rising pri­ces and a loss of purcha­sing power. This makes mea­su­res to con­tain costs all the more urgent. The pre­sent pro­po­sal is to be inclu­ded in the broad discussion.

State­ment of the Fede­ral Coun­cil dated 16.11.2022

1. within the scope of its com­pe­tence, the Fede­ral Coun­cil shall ensu­re that savings poten­ti­al is exploi­ted to the best pos­si­ble ext­ent. Insu­r­ers are requi­red by law to limit their admi­ni­stra­ti­ve costs to the ext­ent neces­sa­ry for eco­no­mic manage­ment. In recent years, they have made invest­ments in infor­ma­ti­on tech­no­lo­gy in order to redu­ce their admi­ni­stra­ti­ve costs in the lon­ger term. Insu­r­ers with lar­ge insu­red popu­la­ti­ons can take advan­ta­ge of eco­no­mies of sca­le to recoup their invest­ments more quick­ly. But smal­ler insu­r­ers can also use infor­ma­ti­on tech­no­lo­gy to redu­ce their admi­ni­stra­ti­ve costs. Moreo­ver, admi­ni­stra­ti­ve costs are also matched by bene­fits. For exam­p­le, stron­ger invoice or bene­fit con­trol is wort­hwhile if the admi­ni­stra­ti­ve costs used for this pur­po­se lead to grea­ter savings in bene­fit costs and thus the costs of the OKP as a who­le can be reduced.

As the super­vi­so­ry aut­ho­ri­ty, the FOPH also sup­ports insu­r­ers in ensu­ring that busi­ness manage­ment and tech­ni­cal pro­ce­s­ses are digi­ti­zed in line with the times. The cost con­tain­ment packa­ge II also pro­vi­des for the mea­su­re “Digi­tizati­on of invoice con­trol”. This is inten­ded to obli­ge all ser­vice pro­vi­ders in the inpa­ti­ent and out­pa­ti­ent sec­tors to trans­mit their invoices in elec­tro­nic form. This is a con­cre­te mea­su­re that makes an important con­tri­bu­ti­on to exploi­ting poten­ti­al savings in admi­ni­stra­ti­ve costs.

2 The que­sti­on of which tech­ni­cal solu­ti­ons are effi­ci­ent for cer­tain ser­vices can­not be ans­we­red in a gene­ra­li­zed way and is the respon­si­bi­li­ty of the insu­r­ers. They are also in com­pe­ti­ti­on with each other and have incen­ti­ves to imple­ment the most advan­ta­ge­ous solu­ti­on for them­sel­ves. The Fede­ral Coun­cil would wel­co­me increa­sed digi­tizati­on efforts by insu­r­ers. Based on Artic­le 6 of the Fede­ral Act on the Super­vi­si­on of Social Health Insu­rance (KVAG; SR 832.12), all insu­r­ers have the opti­on of out­sour­cing their OKP accoun­ting, among other things, to modern cloud ser­vices, pro­vi­ded that data pro­tec­tion and data secu­ri­ty are gua­ran­teed in particular.

3 As in other sec­tors of the eco­no­my, it can be assu­med that invest­ments in digi­tizati­on will only be made by insu­r­ers if cost savings can be achie­ved as a result. The Fede­ral Coun­cil the­r­e­fo­re wel­co­mes all digi­tizati­on efforts to redu­ce the admi­ni­stra­ti­ve costs of health insu­r­ers, which also leads to grea­ter trans­pa­ren­cy and effi­ci­en­cy. Howe­ver, a blan­ket digi­tizati­on requi­re­ment would not auto­ma­ti­cal­ly increa­se efficiency.




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