Cap on psychotherapists covered by health insurance (cross-border guide)

Context

In brief

• Quadri calls for a cap on psychological psychotherapists
• The change came into force on 1 luglio 2022
• ZSR facilities grew by 120%
• AOMS expenditure reached 922 million in 2024

Key facts

• Proposal → cantonal cap for psychological psychotherapists
• Presenter → Lorenzo Quadri (Lega)
• Billing → AOMS on medical prescription from 1 luglio 2022
• Facilities with active ZSR → 2'437 in the third quarter of 2022; 5'374 in the second quarter of 2024
• AOMS costs → 528 million francs in 2021; 922 million in 2024
• Cited legal basis → Article 55a of the LAMal

The request to the Federal Council

On 1 luglio 2022, psychological psychotherapists obtained the possibility of billing compulsory health-care insurance (AOMS) directly, on the basis of a medical prescription. This change is the starting point for the motion submitted to the Federal Council by National Councillor Lorenzo Quadri (Lega).

The text calls for the Cantons to be allowed to set a cap on the number of psychological psychotherapists authorized to bill their services to compulsory health insurance. For Quadri, the sector should have an instrument analogous to that already provided by the LAMal for doctors. Within the LAMal e cassa malati system, the text therefore focuses the request on the number of persons authorized to bill AOMS; the source describes the medical prescription as the basis of the regime that came into force in 2022.

The numerical comparison is at the heart of the motion. Between 2022 and 2025, specialists in psychiatry and psychotherapy increased from 3'974 to 4'141, an increase of 4,2%. During the same period, specialists in child and adolescent psychiatry and psychotherapy rose from 742 to 772, equal to 4%. Psychological psychotherapy facilities with an active ZSR number, on the other hand, increased from 2'437 in the third quarter of 2022 to 5'374 in the second quarter of 2024: more than 120% higher.

Quadri also cites expenditure recorded by Obsan. The costs of psychological psychotherapy covered by AOMS increased from 528 million francs in 2021 to 922 million in 2024, with average annual growth of 20,4%.

The institutional reference is Article 55a of the LAMal. Today, according to the National Councillor, the Cantons can set maximum numbers for doctors in certain specialties, but they do not have an analogous instrument for psychological psychotherapists. The request brought to Bern aims precisely to bridge this difference.

The source thus presents a political request: the growth in facilities, the increase in expenditure and the difference between doctors and psychological psychotherapists are used to support extending quota restrictions to the Cantons.

Operational details

Practical implications for cantons and policyholders

The case of Ticino

The territorial focus identified in the motion is Ticino. According to Quadri, the canton has seen a significant increase in Italian professionals, a consequence of the free movement of people. The national councillor adds that the canton’s per-capita use of psychotherapeutic services exceeds the Swiss average by more than 50%. Quadri presents this percentage as a figure that should raise questions about the actual appropriateness of all therapies.

For a canton, the request would have a precise administrative consequence: the ability to set a maximum number of professionals authorized to bill AOMS, as is already the case for doctors. For anyone using a service under the regime described, the practical distinction would be between the medical prescription, identified as the basis for direct billing, and any authorization within the cantonal cap requested by the motion. The first element stems from the 2022 change; the second is the extension Quadri wants to obtain.

Work and disability pensions

The motion also links the surge in prescriptions to absences from work and the related costs for the economy. The issue is presented not only as an AOMS expenditure item, but also as a matter with economic consequences linked to absences from work. This is the practical point for anyone following costo della vita in Svizzera: the debate puts both the rise in healthcare costs and the economic consequences of absences on the table.

The second connection concerns disability pensions among young people. In 2025, Quadri writes, approximately 2'800 new disability pensions were awarded to people aged 18 to 24; approximately 70% would be attributable to mental disorders. The national councillor uses this figure to argue that developments in the sector require more urgent action.

“It is necessary to ask whether all these new pensions are truly justified,” Quadri says.

The text juxtaposes these figures with the discussion of the rise in prescriptions and absences from work, as arguments in support of intervention in the sector.

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Key points

How to orient yourself before billing

Four concrete steps

The verification can begin with the professional category. The source distinguishes specialists in psychiatry and psychotherapy, those specializing in childhood and adolescence, and psychological psychotherapists. This distinction avoids confusing the increase in specialists with that of facilities with an active ZSR number.

• First: place the service in time. The date to mark is 1 July 2022, the date on which psychological psychotherapists obtained the possibility of billing the AOMS directly.
• Second: verify the prerequisite indicated by the source. Under the regime described, direct billing to mandatory health care insurance takes place on the basis of a medical prescription.
• Third: separate the number of ZSR facilities from the number of specialists. These are quantities used in the motion to describe different phenomena and should not be added together.
• Fourth: distinguish the rule described from the policy proposal. Quotas for physicians are already provided for by Article 55a of the LAMal; for psychological psychotherapists, the motion asks the Cantons for an analogous instrument.

If the request were accepted

The scenario to follow would be the possible cantonal authorization to bill the AOMS within a maximum number. Practical verification would therefore remain anchored to the professional's category, the medical prescription, and the possibility of billing within the framework decided by the Cantons. The available text describes a motion addressed to the Federal Council: Quadri's request must not be turned into a rule already in force.

To complete the verification of your expenses, use the calcolatore stipendio/imposte.

Source: tio.ch