Health insurance: Poggia denounces a game of “liar poker”

An avalanche of reactions. The decision of Groupe Mutuel to no longer reimburse, from May 1, the hospital stays of its policyholders at La Tour Hospital, triggers an outcry. Among the people shocked by this news revealed on www.tdg.ch, Mauro Poggia, former Geneva State Councilor responsible for health, and Michel Matter, president of the Geneva Doctors Association.

“This unilateral decision is shocking. Humans are not a commodity, Michel Matter is indignant. What will pregnant women, athletes or people with heart problems who had planned to be hospitalized at La Tour do? Will they have to give up the recognized expertise of this establishment in these areas and wait longer than expected to be treated elsewhere?

“Be careful, insurers want us to believe that a surgeon can operate anywhere,” continues Michel Matter, “but this is an illusion. An operation is carried out as a team: the surgeon is used to working with a technical platform, certain anesthetists, instrumentalists, etc..”

Joint negotiator?

Mauro Poggia, current advisor to the States, is also worried about the patients who are paying the price for the “lying poker which serves as a strategy between insurance companies and private clinics. I imagine, he said, that the contract between Groupe Mutuel and La Tour is not broken, because termination with immediate effect is not possible. No doubt this is a breakdown in talks and I hope a solution can be found.” How? “For example through a common insurance negotiator.”

For the moment, each clinic negotiates its prices with insurers separately, “for fear of being accused of a cartel agreement by the Competition Commission. In reality, [les cliniques] would do well to talk to each other and not act separately, because, in the long term, this weakens them and strengthens their adversary. Because for their part, health insurers are aligning themselves in a common approach: putting pressure to obtain, clinic after clinic, a drastic reduction in hospital rates.”

The trained lawyer knows this well, he who recently defended the Hirslanden Geneva and Vaud clinics against CSS, the latter having warned its policyholders that it would no longer reimburse their stay at La Colline.

Mauro Poggia notes that “if insurers are tightening the screw, they have refrained from reducing their premiums for decades”. He recalls that “more and more operations are being carried out on an outpatient basis, exclusively at the expense of the LAMal. In addition, since 2012 the Canton has participated in the hospitalization of Geneva patients in clinics. This public financing made it possible to increase the profits of private insurers. Taxpayer money therefore finances the private sector!”

What can the insured do when they learn that they can no longer be hospitalized where they had planned to be? “Unfortunately, legal time does not fit well with health. But a patient, or an association of patients, should one day go to court. He could complain of having taken out insurance guaranteeing him the free choice of doctor and hospital and of suffering, along the way, a fundamental reduction in the promised benefits.

Sophie Davaris is deputy editor-in-chief of the Tribune de Genève where she has worked since 2000. She is particularly interested in local news and public health. More informations

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