Dispute over therapies Federal government wants to save money on healthcare - manufacturers are standing in the way

The Swiss HTA program, which aims to remove unnecessary medical services from basic insurance, is not meeting expectations. This is also due to resistance from manufacturers.

The Swiss healthcare system has enormous savings potential, but a key instrument for cost containment is only being used insufficiently.

The so-called HTA (Health Technology Assessment) program, which has been running at the Federal Office of Public Health (FOPH) since 2015, was intended to remove unnecessary medical services from basic insurance, as reported by theTages-Anzeigernewspaper. However, as an investigation by the Swiss Federal Audit Office (SFAO) shows, the savings achieved fall far short of expectations.

International estimates assume that up to 20 percent of healthcare expenditure in Western countries could be saved without worsening medical care. In Switzerland, it was hoped that the HTA program would achieve annual savings of 180 to 220 million Swiss francs. In reality, however, an average of only CHF 25 million has been saved per year over the last four years - a fraction of the original forecasts.

According to the SFAO, this is mainly due to the fact that too few procedures are carried out and the resistance from stakeholders such as manufacturing companies, professional societies and patient organizations is high. Instead of the planned 18 to 22 reviews per year, there have only been 5 to 11. In addition, objections and legal proceedings are delaying implementation.

Dispute over ineffective therapies

The greatest savings to date have been achieved with medicinal cannabis and vitamin D tests, where there was less resistance from stakeholders. Both measures together generated over 80 million francs.

On the other hand, ongoing appeal proceedings are blocking projects such as iron therapy for iron deficiency without anemia. Switching to tablets instead of infusions could save up to 102 million francs a year, but has remained unsuccessful for ten years.

Another long-standing problem is knee arthroscopy, an often unnecessary treatment for non-accident-related complaints. While the procedure has long been restricted in countries such as Germany, it continues to cost the Swiss healthcare system up to CHF 70 million a year.

Need for optimization

The SFAO recognizes progress compared to 2019, such as faster processes and the greater inclusion of foreign findings. Nevertheless, the number of procedures remains too low and the potential of the HTA program is not being fully exploited. "We will review developments again in three to four years," announces Martin Köhli from the SFAO.

In order to actually curb healthcare expenditure, the FOPH must identify more topics for HTA procedures and increase output. In view of the over 40 billion francs spent annually on basic insurance and a cost growth of up to two billion francs per year, the success of the HTA program to date remains marginal.