CSS Gruppe, the second largest Swiss mutual insurer, is set to start to follow the largest, Helsana, and to start commissioning its own healthcare services. The move means the two largest insurers, representing half the market, will have left the umbrella commissioning scheme ran by Sante Suisse, the association which represents all 90 Swiss mutuals who are in 11-12 large groups.

They hope that they can use their purchasing power to drive better bargains with Swiss hospitals and other healthcare providers.

Paul Rhyn, a spokesman at SanteSuisse told Healthcare Europa: “The two are particularly strong in the supplementary market which is roughly SF6-8n and is the only source of margin for insurers as they forbidden by law from making a profit on the SF23bn statutory insurance market. Basically, they will say to healthcare providers ‘if you want us to give you the higher margin supplementary work, then you will have to give us a better price on the basics.’” This would give them an advantage of the other statutory insurers in the market.

Sante Suisse is responding by moving its commissioning activities into a separate company.
 
Sante Suisse reckons that around 20-25% of all Swiss have recently opted for lower cost managed care insurance packages under which they can only use a specific list of healthcare providers and have to see a family doctor before they can go to a specialist. Rhyn says: “By doing this, the consumer can cut the cost of healthcare insurance by 15-20%. Last year, when we saw a large hike in insurance costs, a lot of people moved to these managed care contracts.”

This makes Switzerland unusual. Attempts to introduce managed care in Germany and the Netherlands have met with little success, possibly because the financial benefits fall far short of the 15-20% savings that can be made in Switzerland. Insurers in the Netherlands who offered a EUR200 discount saw very little uptake.