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HEALTH INSURANCE

EXPLAINED: How to see a specialist doctor in Switzerland without a referral

Switzerland has an excellent healthcare system, and the compulsory insurance allows access to a wide network of specialists — under certain conditions.

EXPLAINED: How to see a specialist doctor in Switzerland without a referral
Your GP is a good source for referrals. Photo: MART PRODUCTION on Pexels

For many foreigners coming from countries with some form of nationalised healthcare — for instance the UK, France or Scandinavian nations — the Swiss system of private insurance carriers may be difficult to navigate.

Often, questions about what services the patient is entitled to under various forms of insurance available in Switzerland abound.

For instance: can you make an appointment with a specialist directly, or do you need your GP’s referral in order for the insurance to pay for the visit?

READ MORE: Everything you need to know about health insurance in Switzerland

This is what you should know

Generally speaking, you can consult specialists without a referral from your doctor — unless your insurance policy states otherwise.

The compulsory basic insurance — KVG in German and LaMal in French and Italian — is quite comprehensive, and in principle also covers “unreferred” specialist visits, provided the doctor is officially recognised and not an unlicensed, back-alley practitioner.

However, there are exceptions to this rule.

In an effort to save money on notoriously expensive health insurance premiums, you might have switched to a cheaper model. If this your case, you are limited in your choice of physicians, including unreferred specialist visits.

These are some of the more restrictive plans:

Health maintenance organisation (HMO)

Under this model, policyholders are required to consult a particular HMO practice. Two disadvantages of this alternative is a limited choice of doctors and you also need a referral to see a specialist.

However, the benefit is a premium reduction of up to 25 percent compared to the conventional insurance.

Family doctor model

Your family doctor, a general practitioner, will be designated by your insurance company and will be in charge of all your medical treatment.

He or she will refer you to a specialist if necessary. 

If you opt for this option, you could save 20 percent on your insurance.

Telmed

If you choose this option, you have to call a telephone service and get a referral to a doctor or hospital.

This does not apply to medical emergencies and other exceptions, such as eye exams and annual gynecological check-ups.

Total savings could range between 15 and 20 percent. 

READ MORE: Five tips for getting cheaper health insurance in Switzerland

Having one of the above policies doesn’t mean you don’t have access to specialist care; it merely means that you can’t choose the specialist yourself and must get a referral to see one.

What can you do to have a free choice of specialists with no referral?

As stated above, if you have a “regular” policy, with no service limits attached to it, you needn’t worry.

But if you have one of the cheaper plans and it is more important to you to be unencumbered in your choices of medical providers than to save money, then your only option is to switch policies.

Choose one that places no limits on the choice of doctors — both specialists and GPs — either through unrestricted KVG / LaMal, or by opting for an upgraded (but also more expensive) plans like supplemental, semi-private, or private coverage.

Aside from the free choice of doctors, these policies also offer more perks, including access to alternative medicine and private rooms in the hospital.

Remember, however, that you can’t switch insurance companies from one day to another. You can only do so at the beginning of a calendar year, and you must notify your current carrier of the change by registered mail by November 30th at the latest.

You don’t have to give reasons for the change, but you will need to present proof that you took out a new policy with another company.

READ MORE: EXPLAINED: How to change your health insurance carrier in Switzerland and save money

And there is more

Even though you may have a free choice of specialists without a referral, keep in mind that your GP can be a good resource nevertheless.

This is especially true if you are a recent arrival in your area, or just don’t know which specialist is most suited to your particular medical issues.

In such cases, the family doctor can recommend someone you may not have been able to find yourself.

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For members

HEALTH INSURANCE

EXPLAINED: How the Swiss health insurance system is based on solidarity

Much has been said about Switzerland’s compulsory health insurance, most of it pertaining to its high — and continually growing — costs. But there is also another aspect of the scheme many people may not know about.

EXPLAINED: How the Swiss health insurance system is based on solidarity

For many people in Switzerland, the obligatory medical insurance is a sore point.

Premiums will likely rise by an average of 5 percent in the fall, and many people could even see their rates soar by more than 10 percent in 2023 — the sharpest hike in premiums in 20 years.

READ MORE: EXPLAINED: How Switzerland wants to cut soaring healthcare costs

While there are some ways to save money on a health plan, overall these policies are expensive, and you will hear many people grumble about this cost — even though Swiss healthcare system is known for its excellent level of care.

What you may have not known is that the whole scheme is based on the principle of solidarity, the extent of which is rare in other nations’ health insurance systems.

What exactly does this mean?

Rather than applying an individual approach to healthcare insurance, Switzerland’s system is based on the idea that all insured people form a group.

You can think of this system in terms of a huge pot to which each resident of Switzerland makes a contribution (that is, premium payments), so that in an emergency there are enough resources available to give someone the help they need when they need it.

This kind of ‘one for all’ approach takes precedence over the ‘to each his own’ attitude prevalent in many other countries.

“This means that even those who are in perfect health and never need to see a doctor pay their monthly premiums and thus indirectly provide for those who are ill and need more medical support”, according to a report by the WIRE research think tank.

In other words, all the people of the same age group living in the same canton pay the same premium, rather than different rates based on their income or other personal circumstances.

This applies only to the obligatory basic insurance (KVG / LaMal); supplemental insurances have a different rate base.

Under this system, “it is the task of the federal government, cantons, municipalities and health insurance companies to keep this group balanced<2, the report says. “That’s why decisions in the Swiss healthcare system are always taken in the interest of the group as a whole».

How did this system originate?

This principle of solidarity between the healthy and the sick has a long tradition in Switzerland and is even enshrined in the health insurance law.

“In practice, this also results in solidarity between young and old, because young people on average have little need of medical care, but the risk of illness increases with age”, the WIRE report points out.

“Uniform premiums also mean that there is solidarity between men and women, as the latter generally claim more medical benefits due to pregnancies and births and longer life expectancy,” it added.

How does this system compare with health policies in other countries?

According to the report, in an international comparison, the Swiss health system “displays greater solidarity than the US health system”, where anyone who is not insured has to pay for medical treatment out of their own pocket, “which is why many people get into debt”.

Switzerland’s approach is “also more liberal than Germany’s where health insurance premiums depend on a person’s income”.

Likewise, it is also more liberal than the health systems in France and the UK, “which rely more on fiscal contributions from the state”.

As for the question whether those countries’ health system are superior to Switzerland’s, the report notes that “this is doubtful because state healthcare systems financed by taxes are also forced to compensate for dwindling tax revenues, for example by increasing deductibles, which reduced the solidarity between the insured in different income bracket”.

READ MORE: How is Swiss healthcare system different from the rest of Europe?

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