- Proposed addition to Art. 56 KVG allows insurers to provide insured persons with individual information on services received, prevention and more economical offers.
- Art. 84 KVG is to be amended to allow insurers to process personal and supplementary insurance data and link it for advisory purposes.
- Debate: Benefits of data for health improvement versus risk of cost reduction as an end in itself; supervision should ensure appropriate use.
In the current business on the “Amendment of the KVG concerning cost containment measures – Package 2” (Business No. 22.062), the National Council will discuss a number of adjustments to the KVG in the 2023 fall session (September 11 – 29) (cf. the Message from 7 September 2022).
On August 31, 2023, the majority of the National Council’s Committee for Social Security and Health (SGK‑N) made an interesting proposal for the attention of the NR in connection with the efficiency requirement (Art. 56 KVG) (cf. the Flag 2023 III N1 D).
Art. 56 shall be replaced by a new paragraph 1bis be supplemented:
1bis In order to ensure the measures pursuant to paragraph 1 [“The service provider must limit its services to the extent that is in the interest of the insured person and necessary for the purpose of treatment.”], the insurers may allow the persons insured with them to inform individually about the services they receive, about measures to prevent illnesses and about offers aimed at improving the efficiency and coordination of the provision of medical services, and, with their consent, the Service providers Provide information on the benefits received by the insured.
Accordingly, also Art. 84 KVG (processing of personal data) must be supplemented (“The bodies entrusted with the implementation, control or supervision of the implementation of this Act or the KVAG are authorized to process or have processed the personal data, including data requiring special protection and personality profiles, that they need in order to perform the tasks assigned to them under this Act or the KVAG, namely to: […]”):
j. measures in accordance with Article 56 paragraph 1bis and to provide corresponding information.
This would provide the legal basis for health insurers in the mandatory sector (OKP) to process personal and non-personal data in order to To advise basic insured persons. Via Art. 84 lit. j KVG, the acquisition of data from supplementary insurance would also be permitted, because the acquisition of personal data is also processing; it would therefore also be possible to link such data (but only in one direction, i.e. not also a disclosure of OKP data to supplementary insurance) – at least as long as no profiling takes place (because a formal legal basis would be required for this).
It is a long-standing concern of health insurers to be allowed to use data to advise insureds and influence their behavior. It can claim to take into account the real situation, namely the fact that basic insurers have more and qualitatively better data at their disposal than is generally the case for service providers (Lerbs), especially since data from several Lerbs converge at the health insurer. The fact that health insurers have an interest in reducing services is not a problem, but rather part of the solution, especially since the actual gatekeepers – the Lerbs – are assumed to have a tendency to be interested in expanding volumes. Since too much treatment can be just as harmful as no treatment or the wrong treatment, some balancing of interests in health care is not wrong. It will be up to regulators to ensure that health insurers use opportunities for the benefit of improving the health of the insured and not to save costs as an end in itself.
Cf. also the Article in the Aargauer Zeitung from September 11, 2023 “Breaking a taboo: Helsana boss wants to relax data protection – and intervene in patient treatment” (paywall).