First monitoring report on the new regulation of psychological psychotherapy

The system change from the delegation model to the prescription model for psychological psychotherapy in compulsory health insurance (OKP) has led to an increase in costs in 2023. This is shown in the monitoring report on the new regulation of psychological psychotherapy commissioned by the Federal Office of Public Health (FOPH). The cost increase is projected to be in the range of CHF 175 to 200 million. A good half of this is due to the new, higher tariff.

Since July 1, 2022, psychological psychotherapists have been able to work independently and on their own account at the expense of the OKP on a doctor's orders. Previously, their services were only remunerated under medical supervision in the so-called delegation model or psychological psychotherapists worked independently in the supplementary insurance sector and for self-pay patients. During a transitional phase, psychological psychotherapy could still be remunerated according to the old model of delegated psychotherapy until the end of 2022, parallel to the new prescription model.

In order to track the effects of the new regulation on costs and care, the Federal Council has planned monitoring and an evaluation. The first monitoring report is now available.

Causes of the cost trend

Representative cost data is available for billed therapies in the first half of 2023. The costs of psychological psychotherapy in the prescription model amounted to CHF 373 million in the first half of 2023 compared to CHF 277 million in the same period in 2022 for delegated psychotherapy.

Invoices for treatments in the second half of the year are sometimes received by insurers with delays. However, the information available for the second half of 2023 already allows projections to be made: Costs of between CHF 700 and 750 million are expected for psychological psychotherapy in the 2023 treatment year. The increase in costs in 2023 compared to 2022 is projected at CHF 175-200 million.

In 2021, the Federal Council estimated that the switch from the delegation model to the prescription model could result in additional costs of around CHF 100 million per year for the OKP. These additional costs were derived from the fact that a proportion of the therapies previously paid for privately or via supplementary insurance would now be shifted to the OKP, as psychotherapists who previously worked independently would now also be able to bill via the OKP. The calculations were based on the assumption that the new tariff would remain the same as for delegated psychotherapy in terms of hourly rates. However, the analyses show that a good half of the cost increase in 2023 is due to a higher tariff compared to delegated psychotherapy. As the tariff partners have not jointly agreed a Swiss-wide tariff agreement, provisional cantonal tariffs are currently still being applied.

Other reasons for the rise in costs can be attributed to the long-term trend of a steady increase in volumes and costs as well as population growth. Just under 30 % of the cost increase is potentially due to shifting effects from the supplementary insurance and self-payer sector to the OKP and possibly other reasons. Extrapolated to 2023 as a whole, the report shows a volume-related cost increase of CHF 50 to 55 million as a result of the model change, which is below the additional costs of around CHF 100 million per year estimated by the Federal Council before the model change was introduced.

In-depth analyses planned

More in-depth analyses, such as on the extent of the transfer of reimbursed benefits from private supplementary insurance to the OKP and the impact of the new regulations on the quality of care, will follow as part of the 2024/2025 evaluation.

Further information:

Documents Polynomics, Monitoring of the new regulation of psychological psychotherapy, report April 30, 2024

Websites New regulation of psychological psychotherapy from July 1, 2022 (admin.ch) Monitoring at the FOPH

Address for queries: Federal Office of Public Health, Media and Communication, +41 58 462 95 05 media@bag.admin.ch

Responsible department: Federal Department of Home Affairs FDHA