Switzerland spends a lot on their health care: treatment in a hospital in Zurich. © Keystone / Michael Buholzer
If they are unwell, the Swiss abroad migrate back to the Swiss healthcare system. There could be another way, says parliamentarian Elisabeth Schneider-Schneiter. Your idea has broad political support.
This content was published on August 3, 2023 – 11:00 am August 3, 2023 – 11:00 am
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The Swiss population is groaning under steadily rising healthcare costs. According to a survey by the Tamedia newspapers last week, these are also the most pressing problem that Swiss politicians have to tackle. For Central National Councilor Elisabeth Schneider-Schneiter, part of the solution lies with the Swiss abroad.
Because among them there are a particularly large number of retirees, and they often need expensive treatments. Pensioners who live abroad often come back to Switzerland for treatment. Especially when a major intervention or treatment is planned.
“Swiss people living abroad register in Switzerland for six months and have a complex operation here,” she says. “It’s a real challenge for the system.” The Central National Councilor is also a board member of the Organization of the Swiss Abroad OSA.
Foreign politician Elisabeth Schneider-Schneiter. zvg
The problem with this treatment tourism: Patients receive services from the Swiss health insurance companies for which, strictly speaking, they have not paid.
Legally exploit the system
After all, anyone who emigrates also inevitably leaves the Swiss healthcare system with its obligations and rights. Although you no longer pay health insurance premiums, you also lose the right to be treated in Switzerland.
However, this is easy to circumvent, because as soon as you take up residence in Switzerland again, the mandatory health insurance becomes due immediately – and the insurance protection is then fully reactivated.
With short-term residence in Switzerland, you can join one of the most expensive and best healthcare systems in the world at practically no cost. That’s legal. The fault – if there is one – lies in the system.
“If someone is treated in Thailand, the treatment costs are significantly lower.”
End of insertion
How often it occurs is difficult to determine. There is, however, strong evidence that the somewhat dubious practice is widespread. The Swiss health insurance company KPT, which traditionally takes out most international health insurance policies for Swiss abroad, does not find any significant difference in the costs they cover, regardless of whether the policyholders live in expensive countries like Japan or in countries where treatments are cheaper like Tunisia or Brazil. This indicates that Swiss abroad who live in a country with dubious health care often come to Switzerland for treatment, SWI swissinfo.ch researched back in 2019.
Special case Thailand
Anyone who asks around in the community will also quickly learn that treatment tourism is mainly coming from the Swiss abroad community in Thailand, and to some extent also from the Philippines.
There are three reasons for this.
The problem arises first only if the health and medical insurance system of the country of residence is so diverse that there is a strong incentive for treatment tourism. This route is not used in EU and EFTA countries.
Thailand is Secondly especially because it is very popular with Swiss retirees and early retirees – the masculine form was chosen deliberately. Low cost of living, warm climate, easy visas; another factor is probably sex work.
Around 6000 Swiss are at home in Thailand as pensioners or early retirees. Many of them have – third – a problem as a result of the pandemic: Since December 2022, they have had to have health insurance for legal residence in Thailand, which covers treatment costs of up to 100,000 US dollars. When Covid-19 was rampant, Thailand’s healthcare system not only reached its limits – it also had many unpaid bills afterwards.
Thailand’s healthcare system stretched to capacity during the pandemic: Bangkok in April 2021. Keystone / Narong Sangnak
Now the private foreign health insurance that is needed in Thailand is generally expensive for people over 70. The older the policyholder, the higher the premiums. For an 80-year-old person, they can amount to up to 40,000 francs a year.
Pensioners in particular who emigrate because their budget is not enough for expensive Switzerland are rarely prepared for such cost blocks. You can hardly lift them either. If there are previous illnesses, it is often not possible to take out health insurance at all.
Involuntary Return
In Thailand, such pensioners now only have the option of going illegally – or returning to their home country involuntarily.
The Swiss community in Thailand has been lobbying for a solution at the political level for some time.
National Councilor Elisabeth Schneider-Schneiter picked up the ball. she beats in a postulateExternal link suggested that affected Swiss abroad could voluntarily remain in Swiss basic insurance. This isn’t cheap either. However, it has the advantage over private international insurance that it does not become more expensive with increasing age.
The Federal Council should show ways to do this, Schneider-Schneiter demands, because the central politician finds it “disgusting that the Swiss abroad have paid premiums for their basic insurance all their lives and possibly never received any benefits.”
Health insurance companies benefit
The argument that she uses can even be quantified: Swiss pensioners in Thailand leave around 250 million francs to the Swiss health insurance companies.
The bill came from Josef Schnyder, he is Vice President of the Swiss Society in Bangkok. Schnyder explains that younger policyholders generally pay a solidarity advance to older policyholders. They pay premiums for services that they would not receive or would only receive when they were old.
However, if someone emigrates before he or she reaches the age of around 60 with expensive healthcare costs, this person has paid in but will never benefit. “Up to this point in time, based on statistical data for the insurance company, a profit surplus of just under CHF 42,500 per policyholder can be calculated,” calculates Josef Schnyder. With 6,000 pensioners who emigrated to Thailand, he comes up with 250 million francs.
Schnyder reports on Swiss people who had to leave their relatives in Thailand for health reasons because they return to Switzerland for treatment. He also knows those who are no longer granted a long-term residence visa because they can no longer produce proof of insurance.
Lower treatment costs
As a board member of the Organization of the Swiss Abroad, Elisabeth Schneider-Schneiter has close ties to the Swiss abroad, but with her postulate she is primarily targeting Swiss health costs. “If someone is treated in Thailand, the treatment costs are significantly lower,” she says.
She has also convinced politicians from all relevant political parties. 35 members of parliament have signed their postulate, including party presidents and faction leaders of several Federal Council parties. “Everyone has realized that this will relieve the Swiss health system,” says Schneider-Schneiter with conviction.
A look at an international hospital in Bangkok: Health care in Thailand is good – and cheap. Keystone / Rungroj Yongrit
The Basel-based parliamentarian is now eagerly awaiting how the federal government will respond to her idea. Because there is another cost argument: if older, impoverished Swiss people from Thailand are forced to return to Switzerland, they can also be a burden on the social system here.
Then the forced return will not only be more expensive for the health system, but also for Swiss taxpayers.
“The state will be relieved”
When swissinfo.ch asked the former Swiss chief diplomat Johannes Matyassy about the subject a year ago, he replied: “People deliberately go abroad, to countries where you can live very well with a Swiss pension. And if it doesn’t work out, then it should the state look again?” Matyassy saw this as “problematic expectations”.
But Schneider-Schneiter says: “On the contrary: the state does not have to take care of them. They relieve them of their burden.”
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