Those who pay cash get operated on faster!
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Switzerland“Absolutely unethical”: those who pay cash get operated on faster
Although basic health insurance would cover the procedure, some doctors request cash payments for operations. They do not issue a receipt. Nor are such payments declared.
Doctors are extremely busy. As a result, some patients have to wait longer for surgical procedures. This sometimes leads them to accept demands that experts describe as “absolutely unethical”: cash payments, “in order to be operated on earlier or even to be treated at all.” And this despite the fact that the procedure would be covered by mandatory basic health insurance. This is reported by the “Tages-Anzeiger” (paid article). No receipt is issued for such payments. Nor is there any other written documentation. The highest amount demanded is said to be 8,000 francs.
Not isolated cases – a high number of unreported cases is suspected
How often such undeclared additional fees are demanded and paid is unclear. Mario Fasshauer, Managing Director of the Zurich Patient Office, assumes “a considerable number of unreported cases.” Across the seven patient offices combined under the Swiss umbrella organization, 32 such incidents have been reported in the past six months, Fasshauer told the “Tages-Anzeiger.” These concern the whole of Switzerland, with a concentration in the Zurich area. He assumes an increase in recent times. “I suspect that among certain doctors it has become known that such additional fees can be demanded without consequences.” The known cases are currently being analyzed.
Unclear legal situation
The situation is not entirely clear: “Preferential or faster treatment of patients with mandatory insurance benefits depending on additional fees is not permitted,” states the Medical Association of the Canton of Zurich. It refers to the principle of equal treatment under the Health Insurance Act. The Department of Health of Basel-Stadt shares this view: “Undeclared additional fees to gain access to medical services are not permitted.”
The Canton of Bern stated that each individual case must be examined. The Canton of Zurich reports that “according to the Health Insurance Act, additional services may be billed if the patient agrees – this could also include prioritizing the timing of an intervention,” according to the “Tages-Anzeiger.” According to FMH President Yvonne Gilli, such services can be legally permissible “within a regulated framework.” What is decisive is that “service providers guarantee at least the standard of mandatory health insurance for all patients.” In addition, it must be a “genuine additional service.”
“Contrary to our guidelines”
For Brida von Castelberg, former head physician of the gynecology clinic at Triemli Hospital and now advisor to the Academy of Human Medicine, “such additional fees are absolutely unethical.” Michele Genoni, President of the FMCH, agrees: “Undeclared financial demands without contractually defined additional services and receipts are not ethical and contradict our guidelines.”
Mainly affiliated physicians, but also employed doctors and general practitioners
According to Fasshauer, the cases mainly concern affiliated physicians who operate independently at hospitals. In some cases, however, employed doctors have also been involved. The Swiss Patient Organization SPO also knows of cases in which general practitioners demanded cash payments, for example during emergency services on weekends. “In one case, the money had to be deposited in cash for the doctor to even examine the child accompanied by the father,” quotes the “Tages-Anzeiger” Cathrine Arnold.
High number of unreported cases: why are incidents not reported?
Arnold names two reasons: on the one hand, consultations often involve additional costs; on the other hand, those affected must “have the courage to come forward with their own name.” Fear can also play a role: many patients are actually satisfied with their doctor and fear that they will no longer be treated afterwards. The SPO advisor recommends “not paying in such cases and seeking a second opinion.” In addition, the Zurich Patient Office has set up a website where such cases can be reported. 1034x
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