Psychotherapy sessions soon to be reimbursed by basic insurance

From July 1, psychologists trained in psychotherapy could be reimbursed by basic insurance. This reform should make it possible to meet the growing needs of the population in terms of mental health. However, psychologists and insurers cannot agree on a tariff.

The associations of psychologists, H+ Les Hôpitaux de Suisse, Curafutura and the HSK Purchasing Community announced on Tuesday evening that they had reached a tariff agreement. They are now asking the Confederation and the cantons to set this tariff structure and this agreed tariff for the whole of Switzerland, in the interest of patients.

The HSK Purchasing Community is an independent public limited company which, on behalf of Helsana, Sanitas and the CPT, purchases medical services under compulsory health insurance. It represents 2 million basic insured persons. Curafutura is the association of health insurers CSS, Helsana, Sanitas and KPT.

In order to improve the situation of the supply of psychotherapeutic services and to facilitate access to care, the Federal Council had decided that, from July 1, psychological psychotherapy should be covered by basic insurance. , provided it is prescribed by a doctor and under certain conditions.

Appeal to other insurers

To introduce the new model (known as the prescription model), the associations of psychologists and H+ conducted intense negotiations with Curafutura and the HSK Purchasing Community to find an agreement on an adequate tariff structure and value. “The pricing partners regret that an agreement including the whole branch could not be found and urge the other insurers to join forces with the transitional solution that now exists,” they explained in the press release.

The rate has been set at 154.80 francs per hour and is valid until December 31, 2024 at the latest. This limitation of validity is justified by the state of the data during the introductory phase and will make it possible to collect the performance and cost data necessary to establish a final solution.

At the same time, this transition solution has the advantage of allowing the implementation of the prescription model from July 1st.

The current system does not allow psychological psychotherapists to make their basic insurance, except if they are employed by a psychiatrist in a practice or clinic and benefits distributed by delegation.

“The delegation tariff that prevails until today is based on Tarmed, an outdated tariff structure and on a model based on an employee’s activity in a practice or clinic. This will change in the future, thanks to the prescription model,” the statement read.

Measures to avoid a rise

By amending the ordinance, the Federal Council explained that measures are supposed to avoid an unjustified increase in benefits. A medical prescription entitles you to a maximum of fifteen psychotherapy sessions. It can be renewed once.

Beyond these 30 sessions, a report must be written to the insurer’s medical advisor for the extension of the therapy. Until now, the number was set at 40.

According to the estimates of the Federal Council, an amount of 100 million francs will be reimbursed by the basic insurance. Today, the costs are borne by the patients themselves and by complementary insurance. In the long term, this figure could increase to around 170 million.

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