Ticino's healthcare system needs new incentives

Context

In brief

• Ticino: the healthcare trajectory is worrying.
• Covid generated extraordinary and long-lasting costs.
• Health insurers may retain a maximum of 5%.
• Up to one fifth of spending may be linked to unnecessary services.

Key facts

• Author → Matteo Galgiani, vice-president PLR Terre di Pedemonte
• Area → Swiss healthcare, with particular focus on Ticino
• Pressure indicated → extraordinary and long-lasting costs linked to Covid
• Administrative spending → maximum 5% of healthcare spending
• Numerical example → from 10 to 20 billion: 5% from 500 million to 1 billion
• Estimate cited → up to one fifth of spending on unnecessary services
• Drugs mentioned → GLP-1-based products against obesity

Matteo Galgiani, vice-president PLR Terre di Pedemonte, describes Swiss healthcare and, with particular emphasis, healthcare in Ticino as a system on a worrying trajectory. The crisis caused by Covid generated extraordinary and long-lasting costs. According to the author, however, the problem is broader: under the current model, none of the actors has a genuine interest in solving it. Every incentive designed for one party triggers blame-shifting onto the others and blocks reforms.

The patient and spending

High insurance premiums and a mechanism that, once the deductible and cost-sharing have been exceeded, allows practically unlimited and free access to services often encourage patients to seek treatment. The very broad catalogue offers services with real or perceived benefits. For the insurance side, guida alla cassa malati can be consulted. Citizens remain the weak link: they vote and decide, but they do not have the bargaining power or resources of large lobbies, including pharmaceutical companies and health insurers.

Health insurers may retain a maximum of 5% of healthcare spending for administration. If spending increases, the absolute share also increases: in the source’s example, from 10 to 20 billion francs, 5% rises from 500 million to 1 billion. For an individual insurer, stopping an unnecessary service may cost more than the savings; for the system, rising spending benefits all insurers.

Supply, profit and arbitrage

Doctors, pharmacists, hospitals and physiotherapists must ensure themselves a stable income. The system offers no concrete incentive to reject unnecessary or superfluous treatments: accommodating demand prevents patients from being lost to more lenient colleagues. Hospitals, also guided by financial objectives, may prioritize quantity over usefulness. The source links a healthcare «bubble» to this mechanism and indicates that up to one fifth of spending is tied to unnecessary services, with risks, contraindications or side effects.

Pharmaceutical companies are presented according to a profit-maximization logic: innovative and profitable drugs, often expensive, do not necessarily coincide with a healthier population. For GLP-1 products against obesity, the source reports that in the vast majority of cases, within one year of discontinuation, much of the lost weight is regained. Galgiani therefore calls for incentives oriented towards public health, non-excessive rewards and mediation by federal and cantonal politics, to avoid family stress and an increase in demand for mental healthcare.

Operational details

Where responsibility breaks down

Galgiani’s thesis translates into a practical question: who profits when a service is provided, and who bears the cost when that service is unnecessary? The source does not point to a single command center. Instead, it describes a chain in which patients, health insurers, providers, hospitals and pharmaceutical companies respond to different incentives. For those living in Switzerland, the most visible effect comes through premiums and the burden they place on the cost of living.

A map of the incentives

The table makes the short circuit visible: each behavior may be understandable for the individual actor, but the collective outcome is growing expenditure. The patient seeks a benefit; the professional protects their income; the hospital looks to quantity; the insurer assesses the cost of oversight; the industry pursues profitability. Responsibility is distributed, and no one alone has the leverage to correct the entire process.

The numerical comparison concerning health insurers clarifies the difference between an unchanged percentage and a higher absolute outlay. The 5% remains the same, but on 20 billion it produces 1 billion instead of 500 million on 10 billion. For a family, rising premiums can become a source of psychological stress; the source links this stress to greater demand for mental health care, fueling a negative spiral. The issue therefore concerns not only insurers’ accounts, but also the relationship between healthcare spending and the cost of living.

For the Cantons and federal policy, the practical consequence indicated by the intervention is the need to mediate between lobbies, professional associations and the electorate. A reform oriented toward a single group risks producing more buck-passing. A shared solution should instead assess whether the incentive keeps the population healthy and whether it prevents excessive premiums. Those who want to explore the family dimension can use the costo della vita in Svizzera as a starting point.

Recommended tools

For an updated estimate, use the net salary calculator and the CHF-EUR exchange comparator.

Key points

From principle to action

The source does not propose a single technical measure, but indicates a criterion: every decision should steer actors toward a healthy population and toward premiums that are not excessive. To turn this criterion into a personal check, one can use a checklist built around the mechanisms described by Galgiani.

Four steps for evaluating a service

1. Define the benefit. Faced with a treatment or service in the healthcare catalog, ask what concrete benefit is expected. The distinction between real and perceived benefit is the first filter indicated by the source: broad access alone does not demonstrate that a service is necessary.

2. Clarify usefulness and risks. Before signing up, ask the provider to explain why the service is useful, what contraindications it has and what side effects it entails. The source reminds us that unnecessary treatments can carry risks, even when they are requested or offered.

3. Look to the horizon. If the decision concerns GLP-1-based drugs for obesity, distinguish the immediate effect from continuity of use. The intervention points to the regain of much of the lost weight within a year of discontinuation, in the vast majority of cases, and describes continuous and prolonged use.

4. Separate the costs. In the personal budget, distinguish insurance premiums, deductible and cost-sharing. These are the elements that the source relates to the propensity to seek care. To explore the insurance topic further, the guida alla cassa malati is available.

A criterion for reading proposals

When evaluating a policy solution, the operational question is whether it changes the incentives of all actors or merely shifts the cost from one side to the other. The criterion indicated by Galgiani brings together public health and the sustainability of premiums, without losing sight of lobbies, trade associations and the electorate. A proposal is consistent with this approach when it reduces reliance on unnecessary services, limits buck-passing and does not fuel family stress and demand for mental healthcare.

To complete the check on the family budget, use the calcolatore stipendio.

Source: tio.ch