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Research - 06.02.2024 - 12:00 

Health insurance in Switzerland: No abuse of the deductible system by insured persons

On behalf of Groupe Mutuel, the University of St.Gallen has analysed for the first time in Switzerland whether insured persons make more use of medical services after exceeding their deductible. Conclusion: The health insurance franchise system does not create any significant financial incentives for medical overuse.

"The rich should pay a deductible of CHF 10,000", "The maximum deductible should rise from CHF 2,500 to CHF 3,500", "The minimum deductible should be increased from CHF 300 to CHF 600": These are all current proposals to reduce healthcare costs and thus health insurance premiums. There is a strong appeal to personal responsibility of the insured. Among other things, people believe that insured persons with the lowest deductible will quickly use up the CHF 300 and undergo unnecessary treatment at the end of the year. 

How does cost sharing – once the deductible has been used up – influence the utilisation of medical services by patients? This question is the subject of much speculation in Switzerland. On behalf of Groupe Mutuel, the University of St.Gallen has investigated for the first time in Switzerland whether insured persons utilise more medical services after exceeding their deductible.

Higher medical consumption remains insignificant

The study by the University of St.Gallen is based on anonymised data from Groupe Mutuel and focuses on the groups of insured persons with the most frequently selected deductibles of CHF 300 and CHF 2500. "The results of this study show that although there is a general pattern indicating higher utilisation after exceeding the deductible, this pattern is not significant. This suggests that our franchise system does not create significant financial incentives for medical overutilisation on the demand side," says Alexander Geissler, academic director and chair of Health Economics, Policy and Management at the University of St.Gallen.

Groupe Mutuel is focussing its research on the prevention of overuse and misuse. "The study has shown us that the franchise system in Switzerland has proven its worth and does not create false incentives for overprovision among either the insured or the service providers. This does not mean that we want to end the discussion about franchises. On the contrary: the continuous adaptation and improvement of our healthcare system remains an ongoing task," says Daniel Volken, Head of the General Secretariat of Groupe Mutuel.

The full study can be found at: econstor.eu

Image: Adobe Stock / Stockfotos-MG

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