Since the beginning of the year, most insurers have been refusing to pay for therapy sessions with psychotherapists in training – with serious consequences. Now the BAG has to clarify the situation.
Many psychotherapists have had their doors closed since January 1st.
Rarely has a system change in Switzerland gone so badly. For a few months, psychologists who have undergone further training as psychotherapists have been able to bill their basic insurance directly. In the past, they had to be employed by a psychiatrist for this. But the change has unwelcome consequences that apparently hardly anyone saw coming: the psychotherapists, who are still in their five-year training, are suddenly missing a large part of their income.
According to the health insurance companies, which belong to the Santésuisse association, there has no longer been a legal basis for reimbursement for their services since the turn of the year. Only fully trained psychotherapists are entitled to this. It is also no longer possible for therapists in training to continue to be under contract with a psychiatrist who was allowed to draw money from basic insurance for them.
According to the psychologists’ association FSP, the jobs of hundreds of prospective psychotherapists are now at risk. And with it the therapy places of their patients: Thousands of people with mental problems could not get the help they need. The Tamedia newspapers reported on practices that had to send psychotherapists in training on short-time work because of the precarious situation.
Legal mandate violated?
The FSP does not want to put up with that: As the association announced on Thursday, it has lodged a complaint against the Santésuisse funds with the responsible supervisory authority, the Federal Office of Public Health (BAG). Their behavior violates the legal mandate and fundamentally questions the continuing education system for psychotherapists. Santésuisse is acting in contradiction to the Federal Council: “The latter has repeatedly confirmed that the services of psychotherapists in further training are to be paid for by the health insurance companies via the caregivers.”
In the new system, these “carers” are experienced psychotherapists with a degree in psychology who work in practices or outpatient clinics. The services of the young psychotherapists who are entrusted to them are paid for by the funds of the other association, Curafutura, without any problems. The BAG should now also force the Santésuisse members to do this.
Whether that will happen is questionable. So far, the BAG has taken the position that the health insurance companies and the psychologists have to see for themselves how they can come to an agreement. The dispute could drag on for months – to the detriment of the patients. Because there are already too few therapy places in Switzerland today, especially for children and young people. The system change should help to remedy this deficiency, but the opposite has now happened.
Desperate Patients
In an open letter to Santésuisse President Martin Landolt, a psychotherapist in training who has been working in a practice for three years describes how she had to announce the end of therapy to 30 patients within a few days. Some burst into tears, others asked why their cash register had not informed them in time. Otherwise they could have switched to one of the more accommodating Curafutura insurers. But that would not have been possible because the decision not to pay was only made after the change deadline on November 30th.
The psychologist concerned points out that some of her former patients would no longer receive therapy – because they could not find a place or because they did not have the strength to develop a relationship with another therapist. And she emphasizes that this increases the risk that the patients will end up in a clinic – with corresponding additional costs.
Santésuisse is fighting back
However, those responsible for Santésuisse do not want to appear as villains in this story. Rather, they blame the FSP for the deadlock. Santésuisse recognized the problems in good time and specifically pointed out the lack of a legal basis. And therefore also supported the BAG’s proposal to extend the previous model by one year. As a result, the psychotherapists in training could have remained employed by psychiatrists for the time being.
Unfortunately, the FSP decided not to go this pragmatic path, writes the health insurance association. “The fact that the FSP has now submitted a supervisory complaint is incomprehensible to Santésuisse and does little to contribute to a common, viable solution for all stakeholders.” Santésuisse calls on the courts, which are also dealing with the tariff dispute, to clarify the situation “quickly and soberly”.