Health insurer wants to reward non-smokers

Insurer Helsana says smoking is one factor that pushes up healthcare costs Keystone Archive

Switzerland’s largest health insurance company is proposing to reduce premiums for health-conscious policyholders.

Helsana says the discounts – which would need government approval – could apply to non-smokers as well as people who eat healthily and take regular exercise.

The proposals come amid an ongoing debate about how to stem the rising costs of healthcare in Switzerland.

Swiss health insurance premiums are among the highest in the world, and are expected to rise by over four per cent this year.

Helsana, which has issued policies to more than one million people, says it wants to reward those who make the effort to live healthily.

Health costs

“We realised that many people don’t exercise enough, they eat badly, and that they drink and smoke too much,” said Helsana spokesman Christian Beusch. “These four factors drive up healthcare costs.”

Helsana believes that holders of its policies would welcome the prospect of being offered reduced premiums for compulsory cover.

The company first made the proposal three years ago, but it was swiftly rejected by the authorities on the grounds that the scheme was not compatible with Swiss legislation.

The law guarantees that the burden of healthcare is shared out equally.

But Helsana maintains that its proposal is fair and that those who look after their health should be rewarded.

“We don’t think that people who take care of their health should pay for those who refuse to make any kind of effort,” Beusch told swissinfo.

Political climate

While the law which sets minimum cover and standards for compulsory insurance has not changed, Helsana believes the political climate has.

The centre-right Radical, Pascal Couchepin, took over as interior minister – with responsibility for the health portfolio – from Social Democrat Ruth Dreifuss when she retired in 2002.

He is considered to be more open to calls for changes to the healthcare system.

The Federal Health Office, which has been overseeing insurance issues since the beginning of the year, declined to comment on the Helsana proposal.

But Alberto Holly, director of Lausanne’s Institute of Health Economics and Management, told swissinfo he did not believe the proposed scheme was feasible.

“Current premiums do not take into account individual characteristics,” he said. “The law would have to be changed for this proposal to be acceptable.”

But Holly acknowledged that the proposal might make people think more about their own health.

“Reducing premiums could certainly have more impact than simply telling people to take better care of their health,” he said.

Passive smoking

Critics of Helsana’s proposals point to the fact that it would be difficult to assess whether individuals are regular smokers or just the victims of passive smoking.

“It’s obvious that we will have to consider the issue carefully,” said Beusch.

“But from what we know, it should be fairly simple to determine if someone has suffered only from passive smoke.”

Helsana says that if the scheme is approved it will not be sending out company employees to check whether policyholders who have qualified for the discounts are smoking, drinking or eating too much.

“We aren’t going to set up an administrative service to check whether people are fulfilling the criteria in their insurance contract,” said Beusch, “and we [would] assume that people are telling the truth when they sign up.”

“But if someone falls ill, we will find out if they played by the rules. And if they haven’t, they will have to reimburse us.”

swissinfo, Scott Capper

Key facts

Compulsory health insurance cost over SFr18 billion in Switzerland in 2003 (SFr12.5 billion in 1996), or SFr2,445 per inhabitant.
Doctor fees total nearly a quarter of the bill, closely followed by pharmaceutical and hospital costs.
In 2002, healthcare spending totalled $5,267 (SFr6,647) per capita in the United States and $3,445 in Switzerland.

In brief

The compulsory basic health insurance scheme covers illness, maternity and – in some cases – accidents.

All insurers offering compulsory health insurance must provide the same benefits, which are defined by law.

Swiss law states that compulsory health insurance covers only benefits that are effective, appropriate and efficient.