Why mental health therapy for many patients in Switzerland is at risk
Up to 10,000 patients in Switzerland may be left without psychotherapy in the new year under planned changes to health insurance cover.
That's because health insurers with the association Santésuisse no longer plan to cover the costs of therapy sessions conducted by therapists who are in training. The association says this is because there is a lack of legal basis to remunerate therapy services by people in further education.
Previously, health insurers only covered therapy if the trainee therapist was contracted by a doctor, according to the so-called delegation model.
Since the middle of this year, psychological therapies have also been generally covered by basic health insurance as long as they were prescribed by a doctor, i.e. according to the so-called prescription model.
But now some insurers are refusing to pay for those psychologists who have not yet completed further training as psychotherapists but are already practising in order to gain experience.
Up until now, the delegating doctor had been the service provider who could bill the therapies of trainees to insurance companies, but this regulation will no longer apply from 2023.
READ ALSO: How to get an English-speaking therapist in Switzerland
The move reportedly affects around 1,500 therapists in training.
The Federation of Swiss Psychologists (FSP) estimates that more than 10,000 patients could be left without a place in therapy as of January.
"In my 60 years in the profession, I have never been confronted with such an untenable situation," Zurich psychiatrist Alexander Moser told the Tages-Anzeiger.
READ ALSO: Switzerland sees mental illness surge among girls and young women
Moser is now retired but still supervises psychologists in further training. "One of them recently told me that she had to inform several dozen patients that their therapy would be finishing at the end of the year," he said.
"The psychologist was on the verge of a breakdown herself." He added that her further training as a psychotherapist was at risk, while she was also worried about her patients.
Why has a row broken out over therapy cover?
Santésuisse said it had proposed to extend the old delegation model by a year, but this failed - partly due to resistance from the Federation of Swiss Psychologists (FSP).
"For us, this is incomprehensible," Santésuisse spokesman Matthias Müller told the Tages-Anzeiger.
READ ALSO: Everything you need to know about health insurance in Switzerland
According to the FSP, the blame lies with the health insurers. The legal regulation is sufficient, said spokesperson Cathy Maret.
She referred to a letter from the Federal Office of Public Health (FOPH) from the beginning of December, which states that those who supervise people in further education in their therapy work are considered service providers.
For the FSP, it is therefore clear that these supervisors can bill the insurance companies. Although for the FSP the legal situation is clear, the organisation is calling on the FOPH to explicitly regulate the assumption of costs for therapists in further training in an ordinance.
"The refusal (to reimburse costs) by health insurers endangers further training and the care of patients," said Maret.
The changes will also affect clinics.
"Without payment by the health insurance companies, care for the patients concerned will soon no longer be possible," warned Dorit Djelid of the hospital association H+.
Between 30 and 50 percent of the psychologists who work in psychological hospital outpatient clinics are in further training, reported Djelid.
"If the financing of these services is no longer guaranteed, hospitals and clinics can no longer provide their services and also no longer train the people," Djelid said.
However, not all patients in Switzerland are affected.
Patients who are insured with Helsana, KPT or Sanitas will not be affected by these changes because these health insurers have a tariff agreement in place, meaning the costs are still covered.
CSS will also continue to pay for therapy services for people in further therapy training, subject to "reservations", the Tages-Anzeiger said.
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That's because health insurers with the association Santésuisse no longer plan to cover the costs of therapy sessions conducted by therapists who are in training. The association says this is because there is a lack of legal basis to remunerate therapy services by people in further education.
Previously, health insurers only covered therapy if the trainee therapist was contracted by a doctor, according to the so-called delegation model.
Since the middle of this year, psychological therapies have also been generally covered by basic health insurance as long as they were prescribed by a doctor, i.e. according to the so-called prescription model.
But now some insurers are refusing to pay for those psychologists who have not yet completed further training as psychotherapists but are already practising in order to gain experience.
Up until now, the delegating doctor had been the service provider who could bill the therapies of trainees to insurance companies, but this regulation will no longer apply from 2023.
READ ALSO: How to get an English-speaking therapist in Switzerland
The move reportedly affects around 1,500 therapists in training.
The Federation of Swiss Psychologists (FSP) estimates that more than 10,000 patients could be left without a place in therapy as of January.
"In my 60 years in the profession, I have never been confronted with such an untenable situation," Zurich psychiatrist Alexander Moser told the Tages-Anzeiger.
READ ALSO: Switzerland sees mental illness surge among girls and young women
Moser is now retired but still supervises psychologists in further training. "One of them recently told me that she had to inform several dozen patients that their therapy would be finishing at the end of the year," he said.
"The psychologist was on the verge of a breakdown herself." He added that her further training as a psychotherapist was at risk, while she was also worried about her patients.
Why has a row broken out over therapy cover?
Santésuisse said it had proposed to extend the old delegation model by a year, but this failed - partly due to resistance from the Federation of Swiss Psychologists (FSP).
"For us, this is incomprehensible," Santésuisse spokesman Matthias Müller told the Tages-Anzeiger.
READ ALSO: Everything you need to know about health insurance in Switzerland
According to the FSP, the blame lies with the health insurers. The legal regulation is sufficient, said spokesperson Cathy Maret.
She referred to a letter from the Federal Office of Public Health (FOPH) from the beginning of December, which states that those who supervise people in further education in their therapy work are considered service providers.
For the FSP, it is therefore clear that these supervisors can bill the insurance companies. Although for the FSP the legal situation is clear, the organisation is calling on the FOPH to explicitly regulate the assumption of costs for therapists in further training in an ordinance.
"The refusal (to reimburse costs) by health insurers endangers further training and the care of patients," said Maret.
The changes will also affect clinics.
"Without payment by the health insurance companies, care for the patients concerned will soon no longer be possible," warned Dorit Djelid of the hospital association H+.
Between 30 and 50 percent of the psychologists who work in psychological hospital outpatient clinics are in further training, reported Djelid.
"If the financing of these services is no longer guaranteed, hospitals and clinics can no longer provide their services and also no longer train the people," Djelid said.
However, not all patients in Switzerland are affected.
Patients who are insured with Helsana, KPT or Sanitas will not be affected by these changes because these health insurers have a tariff agreement in place, meaning the costs are still covered.
CSS will also continue to pay for therapy services for people in further therapy training, subject to "reservations", the Tages-Anzeiger said.
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