IPPTA 11 th General Meeting Singapore 3rd May 2015 Marc Chevalier Member Board of Directors...

IPPTA 11th General Meeting Singapore

3rd May 2015

Marc ChevalierMember Board of Directors physioswiss

Switzerland

2

Agenda

(1) Physiotherapy in Switzerland

(2) New tariffs for physiotherapy

(3) What happened since the last meeting?

3

Agenda

(1) Physiotherapy in Switzerland

(2) New tariffs for physiotherapy

(3) What happened since the last meeting?

4

Physiotherapy in Switzerland

Private prac-tice5727 53%

Hospit-als374235%

Special care homes, nursing homes,

etc.128412%

Number of physiotherapists (2010)

5

Men Women Total0

5

10

15

20

25

30

Treatment by a physiotherapistin the last 12 months (2012)

in % of the population

15-24 years25-34 years35-44 years45-54 years55-64 years65-74-jährig75+ years

Physiotherapy in Switzerland

6

Cost of health care by provider (2012)

Allgemeine KrankenhäuserPsychiatrische Kliniken RehabilitationsklinikenAndere SpezialklinikenPflegeheimeInstitutionen für Behinderte und andere InstitutionenenÄrzteZahnärztePhysiotherapeutenPsychotherapeutenSpitexdiensteAndere (paramed.)Medizinische LaborsAndere ambulante VersorgerApothekenDrogerienTherapeutische ApparateBundKantoneGemeindenKrankenversicherer (KVG)Unfallversicherer (UVG)IV-AHVPrivate Krankenversicherer (VVG)Organisationen ohne Erwerbscharakter

1.2%

Physiotherapy in Switzerland

7

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

1.1%

1.2%

1.3%

1.4%

300

400

500

600

700

800

900

Costs of physiotherapy

in %

of t

otal

cos

ts fo

r hea

lth

care

in m

illio

n C

HF

Physiotherapy in Switzerland

8

Who pays for physiotherapy?

Health in-surances

68%

Accidentinsurances

14%

Disability insurance

2% Patient16%

(2012)

9

Subsequent remarks only valid for health insurances

Health insur-ances68%

(2012)

10

Health care: Dominated by provinces

11

Tariffs in Switzerland

• Compensation is based on a tariff structure (what is paid with how many points) and a tariff agreement (how much is paid per point)

• The tariff structure is the same all over Switzerland. Tariff agreements are determined for each province separately.

• Example:

Structure Agreement

Province

Treatment Taxpoints

Value Compensation

Zurich „Standard“ 48 1.11 CHF

48 x 1.11 CHF

Grisons „Standard“ 48 0.94 CHF

48 x 0.94 CHF

12

Agenda

(1) Physiotherapy in Switzerland

(2) New tariffs for physiotherapy

(3) What happened since the last meeting?

(4) WCPT Congress 2019

13

16 years without change of the tariff

19

98

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

20

14

2015

16 1710 11 12 13 14 154 5 6 7 8 9Years without

change of the tariff0 1 2 3

appeal to the Federal Administrative Court (40 % of the insurer)

negotiations at the provincial level

decision by the Swiss government concerning the calculation basis

negotiations at the national level

discussions at the national level

negotiations at the provincial level

collective agreement is terminated

negotiations at the national level

negotiations at the national level (60% of the insurer)

imposition of tariffs by the provinces

appeal to the Federal Administrative Court (60 % of the insurer)

collective agreement with all insurances

14

How tariffs are established

1) Primacy of negotiation

2) Imposition of tariffs by the 26 provinces

3) Decisions by Federal Administrative Court

15

Partial solution

• For 60% of the insurers: Negotiations were partly successful Tariff agreement was made Insurers compensate about 50% of the

inflation

• For 40% of the insurers: Negotiations were not successful Insurers propose to compensate about 25%

of the inflation that is not acceptable

Imposition of tariffs by the 26 provinces

16

Contract with 2851 pages

17

Agenda

(1) Physiotherapy in Switzerland

(2) New tariffs for physiotherapy

(3) What happened since the last meeting?

18

Public campaign: 2014

19

Public campaign: 2014

20

Public campaign: 2014

The insurance initiated legal proceedings for unfair advertising …

… but clearly lost the case. The public campaign was considered for being a political campaign.

21

2015: New tariff structure is negoiated

22

Agenda

(1) Physiotherapy in Switzerland

(2) New tariffs for physiotherapy

(3) What happened since the last meeting?

Thank you for your attention!