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Lots of costs, little transparency. There is enormous savings potential with incorrect invoices.
A sore knee. A quick visit to the family doctor. And then an MRI scan in the “tube”. As a patient, it is difficult to classify the performance of this treatment, let alone estimate its costs.
“We are talking about 10 to 15 percent of outpatient services that are wrongly billed. Extrapolated to the industry, this is one billion francs,” says Larisa Petrov. In her doctoral thesis, she examined over-billing by doctors and hospitals.
“Extrapolated, the savings potential is enormous,” says Petrov. However, she emphasizes that most service providers bill correctly. So it’s just a matter of a few cost drivers.
Case in point: the knee
“In radiology, for example, with the standard knee MRI treatment, we observe that the personal care provided by the specialist is systematically billed, even though in most cases the patient does not even see him,” explains Petrov.
As a patient, I am less willing to jeopardize the relationship of trust.
The patients are in a very difficult situation: “Ultimately, they are the ones who suffer. Suppose a specialist has overcharged for 15 minutes – as a patient, I am less willing to jeopardize the relationship of trust.”
How to counteract cost growth? “One possibility is to set incentives in the form of flat rates for very homogeneous treatments, as is done, for example, in ophthalmology,” says Petrov. “The retrospective controls could also be carried out across the board.” The third variant would be to raise awareness among patients. Here you have to be careful not to transfer the burden to the patients.
“The controls are very complex,” says Petrov. But: “Thanks to digitalization, it is now possible to systematically process and analyze health insurers’ data. It is now also possible to identify service providers who systematically and unjustifiably invoice individual services in connection with a specific treatment.” Some health insurers are already applying these systematic controls.
In the fight against abuse, we were able to correct around 36.5 million last year.
“In total, we are talking about ten percent of the services that are not correct,” says Dieter Siegrist, head of the performance audit of the CSS health insurance company. “Last year we were able to correct 797 million francs by checking 23.5 million invoices.” However, this also includes incorrect or duplicate invoices. “In the fight against abuse, we were able to correct around 36.5 million last year,” says Siegrist. His team has recently been significantly expanded.
Urs Stoffel, member of the central board of the Swiss Medical Association FMH and tariff specialist, questions the methodology and projections of the study. “Taken across the entire industry, we highly doubt the 10 to 15 percent figure.”
There may be disagreement about the exact number, but most people probably want to put a stop to billing tricks. Because: “The individual service providers who bill incorrectly enrich themselves at the expense of their specialist colleagues and at the expense of the general public,” says Petrov.
You can see more on the topic this evening in “10vor10” at 9:50 p.m. on SRF1.