Insurance

On January 6, 2025, a new association in the Swiss health insurance industry, prio.swiss, began operations. It consolidates the efforts of two former associations, curafutura and santésuisse, and takes over their activities to represent the political and economic interests of the insured. The prio.swiss represents approximately 90% of individuals insured under Swiss mandatory health insurance system (OKP).

In December 2023, the Swiss parliament adopted the uniform financing of outpatient and inpatient services (EFAS). Currently, inpatient benefits are financed jointly by health insurers and the cantons, whereas outpatient services are entirely funded by the insured. The EFAS will come into force in January 2028 and bring a uniform way of financing inpatient and outpatient services; the healthcare system is expected to be integrated into this system four years later.

In October 2022, the Dutch Healthcare Institute (ZIN) launched the project “Continued development of coverage management: Implementation of the use of disease models”, which will run for three years to gain more knowledge about the development and application of disease models for the assessment of technologies for coverage within basic health insurance.

On July 1, 2023, the updated Framework Contract that defines Romania's social health insurance benefit package entered into force. The Framework Contract defines the SHI benefits package, the conditions for providing services and payments. The updated Framework Contract will be valid for the years 2023-2024.

In April 2023, the Dutch Healthcare Institute (Zorginstituut Nederland, ZIN) published the updated 2023 version of the assessment framework of the "state of science and practice" criteria, including the assessment framework itself, modules with additional explanations for its application, and other information material.

On August 11, 2021, the Dutch Healthcare Institute (ZIN) published the assessment of Oncotype DX®. The assessment was conducted to confirm whether the test complies with the criteria of "science and practice" to determine if it can be reimbursed under the basic health insurance package. In conclusion, the test can be reimbursed under the basic health insurance package.

On July 1, 2021, the updated Framework Contract that defines the social health insurance benefit package in Romania entered into force. The Framework Contract defines the SHI benefits package, the conditions for providing services and payments. The updated Framework Contract will be valid for the years 2021-2022.

According to the available financial results, published by the German Federal Ministry of Health, the German statutory health insurance companies reported a total deficit of around 2.65 billion euros in 2020. The health fund reported a deficit of 3.49 billion euros in 2020. As of January 15, 2021, the health fund's liquidity reserve was around 5.9 billion euros.

On January 1, 2020, as a part of healthcare reform in Austria, the Austrian health insurance fund (Die Österreichische Gesundheitskasse (ÖGK)) was created by merging the nine former regional health insurance funds. The ÖGK is based in Vienna.

Adding the MammaPrint® to the standard risk assessment in patients with early-stage breast cancer has not demonstrated health gains compared to the current way of determining whether a patient needs chemotherapy. Dutch National Health Care Institute has concluded that the test is not eligible for reimbursement from the basic insurance package.

In mid-September 2018, the Swiss Federal Council has placed in consultation the first group of actions that are intended to contain costs in the healthcare sector. The suggested measures will be discussed with all relevant healthcare stakeholders (tariff partners, Cantons, industry and patient associations). These measures should save hundreds of millions of Swiss francs in the long term.