Here’s a breakdown of the key information from the provided text, focusing on the AOMS (Swiss mandatory health insurance) and the HTA (Health Technology Assessment) program:
1.Rising AOMS Costs:
* significant Increase: The average cost of AOMS per insured person dramatically increased from 1723 to 4482 francs per year.
* Multiple Causes: This increase isn’t solely due to expanding services. Other factors include demographic changes, technological advancements, increased service utilization, and incentives within the pricing system.
* Service Expansion Not Always Costly: Adding a new service doesn’t always increase costs; it can sometimes reduce costs by replacing less efficient treatments.
2.KVG Benefits & Supplementary Insurance:
* EAE Criteria: The law requires regular evaluation of all healthcare services based on Effectiveness, Appropriateness, and Cost-Effectiveness (EAE). Services failing to meet these criteria are no longer reimbursed by AOMS.
* two-Tier Medicine Concern: Transferring KVG-covered (basic insurance) benefits to supplementary insurance (optional insurance) if they meet EAE criteria is considered undesirable by the Federal Council, as it could create a two-tiered healthcare system.
3. HTA Program – Evaluation & Savings:
* Purpose of HTA: HTA is a rigorous process for evaluating the effectiveness, appropriateness, and cost-effectiveness of services covered by AOMS. Independent institutes conduct the evaluations.
* Decision-Making: HTA recommendations go to the FOPH (Federal Office of Public Health) and the DFI (Federal Department of Home Affairs) who decide on reimbursement, cancellation, or limitation of benefits.
* Postulate 23.4341: This prompted the Federal Council to assess the FOPH’s HTA practice, propose improvements, and consider an independent HTA agency.
* savings Achieved: The HTA program currently saves around 150 million francs per year, with additional indirect savings from improved care quality.
* Areas for Advancement:
* Identify and evaluate more services of questionable effectiveness.
* Increase involvement of relevant stakeholders.
* Better interaction of HTA results to inform performance-based reimbursement decisions.
* Periodic evaluations to verify implementation of decisions (resource dependent).
4. Independent HTA Agency:
* Current Structure: the HTA program is coordinated by a section of the FOPH, which outsources the actual evaluations to external agencies.
* Federal Council’s View: Creating a fully independent HTA agency would be costly and isn’t justified by any structural problems.
In essence, the document highlights the challenges of rising healthcare costs in Switzerland, the importance of evidence-based decision-making through the HTA program, and the ongoing efforts to improve the efficiency and effectiveness of the healthcare system.