Swiss Mental Health Care System
The prevalence of psychiatric illnesses in Switzerland is comparable to that in other developed countries. Mental health inpatient treatment is mainly provided by public general hospitals, state psychiatric hospitals, private psychiatric hospitals, and residential facilities. The canton financially supports public and private psychiatric hospitals that are on the government hospital list, which is determined by the government and confirmed through regular audits. presents comparative data on hospitalization rates, length of stay, and mental health expenditures. The number of private hospitals is increasing in Switzerland, but the number of patients treated in inpatient settings has remained relatively stable in recent years .
The direct and indirect costs of psychiatric disorders, including costs due to alcohol consumption, are lower in Switzerland than in the United States. Primary care physicians, psychiatrists, psychologists, registered nurses in private practice, psychiatric outpatient clinics, public clinics, and visiting nurse services provide outpatient treatment. Fees for outpatient psychiatric services are calculated by using the TARMED tariff system, which regulates the rates for various procedures, including continuous psychotherapy if indicated. In private practice and outpatient clinics, reimbursement varies according to the monetary value attributed to the tariff points set by TARMED by the canton and the health insurance companies. The tariff points differ depending on the profession of the provider, for example, physician, psychologist, nurse, and social worker, and the procedures. Regardless of the health insurance or the insurance plan, providers receive their payments at similar rates for equivalent medical services, which avoids preferential treatment of patients on the basis of their insurance .
Coverage for intermediate levels of behavioral health care differs depending on the canton. However, most services, such as visiting mental health nurses (called Spitex) and day treatment programs, are covered and regulated according to the TARMED tariff points. Some cantons choose to negotiate certain intermediate health care services, such as home treatment or crisis intervention services, directly with the insurance companies, establishing a flat rate for the services rendered.
Swiss residents can receive outpatient mental health care in a variety of facilities, including private practices and public clinics. Patients are liable for a 10% copayment for outpatient services, up to a maximum of US$700 per year . For example, 60 minutes of psychotherapy provided by a psychiatrist in Zurich costs approximately US$200, with a US$20 copayment. The cost of medication varies according to the choice of brand versus generic products, with a 10% copayment for generic medications and a 20% copayment for brand-name medications ). For example, a one-month supply of escitalopram 10 mg will cost the patient approximately US$50 for the brand-name drug, with a US$10 copay. The generic medication will cost about US$20, with a US$2 copay. In the United States, the same drug can cost the patient around $250 for the brand-name drug and $120 for the generic.
The canton and the basic health insurance companies share the cost of psychiatric hospitalizations, with the amount paid by the state varying by canton and on an annual basis. The patient is responsible for a copay of 10% until the maximum deductible of US$700 is reached. The costs of inpatient psychiatric care are calculated in the form of per diem rates. The rates decline with increasing length of stay, which creates an incentive to reduce the length of stay . The 2012 health law reform has shifted the methods of hospital financing. Switzerland will be switching to a performance-oriented reimbursement method for psychiatric inpatient treatment . In 2018, the government will implement the new tariff structure (TARPSY), which will be based on diagnosis-related groups and psychiatric cost groups, taking into consideration different severity and complexity ratings. The goal is to increase transparency and comparability of services, costs, and quality. It is not the goal of the new tariff system to solve the inherent tension between medical and economic interests but to create a tariff system that is based on data provided by the institutions and is able to adjust more quickly to new changes and challenges of the health care system. This Swiss model allows for psychiatric institutions to compete in a free market for complementary and supplementary premium services without jeopardizing basic mental health services for the entire population.