Cost of Health Insurance

glina · July 13, 2018, 4:41pm

I might have misinformed you slightly. The website states:
“Jeder Leistung ist je nach zeitlichem Aufwand, Schwierigkeit und erforderlicher Infrastruktur eine bestimmte Anzahl von Taxpunkten zugeordnet. Dabei unterscheidet TARMED zwischen der ärztlichen und der technischen Leistung.
In den einzelnen Kantonen gelten unterschiedliche Taxpunktwerte, da das Tarifwerk TARMED die ursprünglichen kantonalen Tarife kostenneutral übernommen hat.
Die verschiedenen Leistungspositionen im TARMED verlangen häufig eine bestimmte qualitative Arzt-Dignität, d.h. bestimmte fachliche Qualifikationen, um eine bestimmte Leistung zu Lasten der Sozialversicherung abrechnen zu können (Facharzttitel, Schwerpunkte, Fähigkeitsausweise).”

So, more experienced, better educated and better equiped doctors can charge more based on a point system.

Sure, the system is constructed in a way that no one is at a loss, but I don’t see doctors cutting corners by using outdated equipment or having generally poor infrastructure.

Bojack · July 13, 2018, 4:49pm

I don’t know man, are on the healthcare’s pocket or is it the girlfriend? I’m saying I can’t compare prices of a medical procedure and you keep fighting me on this. So can I, or not? Do I have a choice between going to a cheap crap doctor or a top class expensive one? Can I see the prices up front?

On a different subject: you guys are saying you would like to have a higher “franchise”. Right now the typical monthly rate for a 2500 CHF franchise is 250 CHF. How much would you be willing to pay for a 5000 CHF franchise? How much for a 10000? Just curious how your mustachian, analytic brains crunch these numbers

glina · July 13, 2018, 4:57pm

It’s the wife, not a girlfriend. You’ve got to invest wisely ;-).

Yes you have a choice. For starters, you don’t go to see a professor if you have a flu ;-).

Probably not. You’can get a price on the medical service probably, but the bill will be full of supplementary costs. Just like at a car mechanic. Damn AMAG once charged me 15 CHF for topping up windshield washer fluid.

Get prices for each level from Comparis into an excel sheet and extrapolate.

ma0 · July 13, 2018, 7:04pm

150.- ? Where should I sign?

I’m not sure I would go higher than 5000 though. Maybe I should insure that amount ahha.

Joey · July 13, 2018, 8:40pm

5000.- is what I would be comfortable with too. I hope they consider raising the max 2500.- sometime soon

Bojack · July 13, 2018, 9:41pm

I guess more reasonable deductible options would be 1000, 3000 & 5000.

The current choice is retarded. Just have a look at this chart. I put here the insurance premiums of Assura from Comparis.

Clearly, if you expect medical costs under 2000 per year, you go for 2500 deductible. If they are above 2000, you go for 500 (or 300). So the options 1000, 1500, 2000 are completely useless, confusing, and there is anyway not so much difference between them.

glina · July 13, 2018, 9:32pm

People like to have a “choice”. I can also remember price anomalies where a franchise of 1500 or 2000 cost only a tiny bit more than 2500, most likely to lure clients and charge more in a year.

Did you also account for the fact that you pay 10% of all your bills until you reach 700 CHF (so 7000 CHF in bills)? This is irrespective of the franchise chosen.

Bojack · July 13, 2018, 9:38pm

Lol, I give you a chart from Assura which clearly proves that 1000, 1500 and 2000 are useless and you just say that “people like to have a choice”…

Yes, look at the right end of the curves, it flats out. For example, by medical bills of 10’000, you will pay 500 deductible + 12 * 400 premiums + 700 coinsurance = 6000.

In fact, since these lines are so evenly distributed, I added a few more lines to reach deductible of 5000, and I got 150 monthly premium, so it was a sweet shot @ma0

glina · July 13, 2018, 9:39pm

Indeed. Both are true

Grog · July 14, 2018, 5:43am

I’m not sure free market would work. People already go to the doctor for every small thing… Let’s imagine a 5 chf per hour doctor that tells them they have nothing. Do they accept it? Nope they will never trust such a cheap doctor. In health stuff people wants all the most expensive options because pricer =better.

Karol · January 4, 2019, 12:48pm

I like this plot

What I find interesting is that Comparis states it clearly:

franchise: 2500 if you expect your expenses to be under 2000 CHF/year
franchise: 300 if you expect your expenses to be over 2000 CHF/year

I go with the cheapest option unless I have “a doctor year” for which I go with the lowest franchise (and Assurance de base) and have all needed (planned) consultations scheduled starting from beginning of January (and yes, scheduling has to be done much in advance to get the first appointment, the following appointments and the treatment done in a single calendar year

2018 was my “doctor year”, and I learned a lot about which medication (as an example: dafalgan = yes, aspirin = no) is reimbursed with LAMAL. Do you have any experience with “Assurance de Base” and different providers? I assumed they are all the same (aside from paying for stuff from your own money and being reimbursed vs. having it covered), so I still went for Assura in my “doctor year” but I am not sure if by chance there is no some hidden profits with other providers of LAMAL.

There is also a tax discount benefit to consider, right?
Can you deduct from your income all expenses (franchise, 10% and non-reimbursable medication, also abroad)?
Do you have any experience with deducting foreign medical costs?

trotro · January 4, 2019, 2:18pm

I don’t know wether I’m missing something but I think this advice is not sound.
I think they only calculate the tipping point of where you pay less and don`t take into account how much you pay less.
In turn this advice is only true if you either know that your expenses will certainly be above (e.g. if you have some chronic ilness) or below 2000CHF/year (e.g. if you never see a doctor out of principle). Most people are probably in a situation where they put some probability of their expenses being below AND some probability of their expenses being above 2000CHF/year.

Using this: https://www.monsieur-sante.ch/de/franchisen-rechner/
And using the some random monthly premiums I could find for my case.

For expected expenses of 0CHF/year I get:

So, I would pay 1530CHF more with the minimum franchise compared to the maximum.

For the expected expenses of:
(approx.)

500CHF, I`d pay 1340CHF more
1000CHF, I`d pay 1000CHF more
1500CHF, I`d pay 450CHF more
2500CHF, I`d pay 450CHF less
3500CHF, I`d pay 450CHF less
4500CHF, I`d pay 450CHF less
7000CHF, I`d pay 450CHF less

So, they are right about the tipping point, but the spread is very different if you`re below 2000CHF than above.

So if I’m right and you’re expected expense value is 2200CHF and you had a nice bell curve around that number, you should probably still go with the maximum premium.
I’m not sure where the actual tipping point of total expected expenses is but it depends a lot on the probability distribution of your expenses and not simply on the expected value.

Bojack · March 3, 2019, 7:05pm

Btw I’m just doing my 2018 tax declaration and I had a look at my Assura bills (classic model). This inflation is just bonkers…

2015: 180 CHF/month
2016: 200 CHF/month
2017: 230 CHF/month
2018: 250 CHF/month
2019: 265 CHF/month

Why is it going up so fast? At this rate, in 20 years I will have to pay 700 CHF/month…

nugget · March 3, 2019, 8:18pm

yes it’s bonkers. huge wrong incentives in this health system. i dont know the details, but obviously noone earns more if they save some money…

Bojack · March 3, 2019, 9:05pm

And of course I paid all my bills myself, Assura didn’t have to pay a single Franc. Maybe I’m getting old and my expected health costs are increasing

Joey · March 3, 2019, 9:05pm

I hope it won’t keep continuing going up like this.

I’m somewhat lucky right now, I switched to the cheapest insurance I could find for 2019 and pay only 140.- (because I am below 25, after that I gets ~100.- expensiver).

The biggest health insurer Helsana said that their costs actually went down for 2018, my hope is that this trend continues / stabilises.

But maybe we do have to busget for 700.- / month in 20 years time, what do you guys think?

oozoo · March 4, 2019, 12:47pm

I think it is absolutely reasonable to expect 700 per month in 20 years. Look at the US rates today

wapiti · March 4, 2019, 1:17pm

Cost will increase, but shouldn’t be as high is this U.S due to public policies and same prices between hospitals.

Dago · March 4, 2019, 4:32pm

I don’t think this is true. The amount a doctor or a hospital charges is decided in the TARMED in the frame of the LAMAL. Hospitals have an additional layer : the “forfaits” which specify how much is reimbursed for an act, e.g. appendicitis, regardless of the number of nights and extra care someone will spend.

Bojack · March 4, 2019, 5:31pm

Yeah there is the TARMED, which means there is no market economy. Good doctor, bad doctor? Zurich or some village? The price is always the same. So good doctors have full schedules and bad doctors just go out of business, I guess.

Also, the doctors will try to put everything possible from the TARMED in your bill. Did the doctor mention that you can go to his friend to make that next procedure and give you his visit card? That’s gonna be 30 CHF.

And you only find out what they put after a month or two, when you no longer remember how the visit went down.