This item followed upon an official statement diffused by santésuisse at all the news services of the country during the Easter weekend in which the private health insurers lobby denounces certain tariffs applied by 4% of the doctors in Switzerland. The Swiss Medical Association shouts with the scandal. In fact, by looking at there more closely, the mountain gives birth to a mouse.

Indeed, only 30% of supplies delivered by less than 4% of the doctors (that is to say less than 700 doctors concerned - 1/3 of 1991 doctors, all specialities inclueded , in other words 1.2% of not-justified or overcharged services) are concerned with this denunciation of the powerful lobby of the Health insurers. The SFOPH notes per year, during the pointings of control which it carries out, practically 1200 errors or abuse during the fixing of premium for Obligatory Health Insurance (OHI) by certain insurers of the country. However this figure never justifies the main headlines of the press. That one is not mistaken there! This denunciation falls at appointed time and will not have the least consequence on medical activity in Switzerland. The political campaign for the termination of contract obligation jsut began and all the blows seem allowed so that its fans can still obtain the implementation of it before second half of this year. Which are thus the reasons for such an eagerness? What is understood by "termination of contract obligation" for the insurers? It acts neither more nor less in the spirit of those last ones to enable them to freely choose the doctors with whom they intend to work, in other words to choose those of which they intend to refund the supply.

Entire Freedom given to insurer or the vacuum of the black list

In the facts, the cases will be able to never define only a list of black sheep of the medical profession.These lists, according to any probability, will be drawn up by a tripartite commission (Federation of Doctors ou/et H± the Hospitals of Switzerland, State (Canton or Confederation), santésuisse). The insurers know it, they will be minorisés within such a Commission, in spite of financial means they have. There will be thus nobody (or almost…) on the black lists. Actually the objective is not much to make bend the medical profession or to weaken medical doctors during tariff negotiations but  to create a feeling of fear-panic at insured side, to create the conditions of fear necessary to agitate the lambda citizen. Communicating remains the main goal of the pathway. Moreover, the insurers find with ease political relays embarrassing itself of any reserve to defend, nozzle and nails, the end of obligation to contract, the rights and freedoms of the insurer against the obligations and duties of the insured. Never contract of insurance will have been at this unbalanced point.

Finally imagination in an advertising campaign

However, in the event of a termination of contract obligation, the freedom lately acquired by the insurer is not where it is awaited. As we saw, Health insurers will not be able to exclude alone from the doctors of the lists of refunded therapeutists. These lists will thus remain undoubtedly empty. On the other hand, the cases will remain free to propose a complementary insurance, under the regime of the LPC, for stage at the pseudo-end of the free choice of the doctor. All the play will be then to manage to impose it, more than to propose it, like the only rational alternative to a hedging made potentially incomplete by this political decision. With this intention, it is necessary to put in scene a hypothetical risk of shortage near the citizen-consumer, in particular leaving it fantasmer on the fact that its doctor could, in the future, not to be dealt with more.

A profit margin of almost 100%

It thus does not matter the height of the premium account of this complementary insurance (hardly more Sfr 10.  -or less not to throw into a panic porte-monnaie immediately);the interest is especially in the profit margin which it could generate. Which margin?Nearly 100%. Indeed, put aside, the expenses of opening of file, such an insurance generates any cost, neither administrative, nor of settlement of services, since it is not provided for any counterpresents with the premium account. If no doctor is on the list, consequently, there will be no expenses administrative inherent in control and thus any settlement additional with those right now provided for by LAMal and dealt with by the premium account of the OHI.

Thus, if santésuisse manages its campaign well, and let us not doubt we, the vagus nerve of hysteria which it will have caused in the population should be such as nearly two thirds of ensured this country will be convinced of the need for subscribing to this new complementary insurance. If santésuisse did not arrive to this figure with financial means of which it lays out, its failure would note of the incompetence. There is today 7' 300' 000 residents constrained to be ensured in Switzerland. According to this projection not far from 5 million of them will subscribe to this "offer", that is to say a figure which could reach the 600 mios franks of premium accounts cashed annually in counterpart of which no service would have to be offered. Who misuses whom in this business?

The war of numbers

Some will see in this projection a lawsuit of intention to the private Health insurers which repeats to put all works about it to control the increase in the costs of health. The latter bring readily lawsuits of intention to the whole population described sometimes as immature, sometimes as irresponsible and do not hesitate to agitate the all year long the spectrum of  abuse, cheating or  "swindle" of such doctor or such insured. It is thus high time that the similar one their is returned. Others, perhaps the same ones besides, will reproach us for forwarding in this analysis of the erroneous figures or completely unrealistic persons. And after all, who's guilty? The only data available, today whereas even the SFOPH does not have any other about it, are those, prone to guarantee, forwarded by santésuisse. They are thus only not easily verifiable because initially when the policy-holder-customer makes a clear request, it obtains data not-in conformity at its request, in the same way, In addition, when it makes the request of it in front of a Court (professional cf secrecy held up at the time of the action taken by the ASSUAS at the TF). In addition, when figures are forwarded all the same, they still result and always of sempiternal "the datenpool santésuisse" and cannot thus be corroborated by the figures of another source.

Pascal Couchepin, Great Pedagogue of the actuarial cause and Federal Concilor to the service of a certain public

In the final analysis, which would be the most profitable operation for an insurer lambda?To obtain, in the facts, the lifting of the obligation to contract and thus to find themselves compels with the control and the update of the famous black list, being constrained to institute the proceedings necessary and, if necessary, to finish by having to refund services?Perhaps an imbecile would think of it. More realistic scenario:to obtain the end of the obligation to contract only only for the form and to take care of nothing, if it is not cashing of the premium accounts of the complementary insurance for free choice of the doctor. In any case, Pascal Couchepin prepares the spirits there to believe his disillusioned statements of them, in a maintenance given in the columns of the 24heures and in which it claims to suspect the insurers of not having the means necessary to an effective control of the doctors who misuse. That resembles extremely a consent of failure before the hour, unless it is not acted in fact of a watchword on behalf of the Head of the Department of Home Affairs to his troops:"do anything, especially nothing!To cash premium accounts does not require any specific competence and generates beautiful incomes!". Unfortunately answers to questions above-mentioned could not delay.