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.