Some Swiss doctors are demanding thousands of francs in cash from patients before operations, sometimes without providing receipts or clearly explaining the charges, according to an investigation by SRF. Patient advocates say the practice is becoming increasingly common and may in some cases breach Swiss healthcare rules.
The Zurich Patient Centre says it has documented more than 40 cases since the end of last year. The issue has now reached the political arena.
One patient sought treatment from her gynaecologist for a painful cyst. She says she was told she needed surgery, but that because the procedure would be performed on an outpatient basis, the doctor would not earn enough under standard insurance reimbursement.
According to her account, the doctor demanded an additional CHF 1,200 on top of the normal bill. When she asked for an invoice she could submit to her health insurer, she says he replied: Bring the money in cash in an envelope at the follow-up appointment. I was genuinely shocked to hear that in Zurich, in Switzerland, she said.
The Zurich Patient Centre says some doctors ask patients to pay extra in exchange for faster access to surgery appointments or enhanced treatment. In many cases, however, the additional payments are not formally documented. Mario Fasshauer, the organisation’s director, says some demands range between CBF 8,000 and CHF 12,000 in cash.
Under Swiss law, additional charges are permitted only if patients receive clearly defined extra services. Franziska Sprecher, a professor of law at the University of Bern, says doctors may legally charge more for services such as accelerated treatment for non-urgent cases or more extensive care than that covered by compulsory insurance. Cosmetic procedures not reimbursed by insurers may also incur additional fees. But any surcharge must be transparent. Patients must be informed not only medically but also financially, says Ms Sprecher. Receipts and clear explanations are part of that obligation.
In the case above, the doctor reportedly argued that standard insurance tariffs did not cover his costs and that he had treated her quickly and on a day off. But for urgent procedures requiring prompt treatment, such justifications are unlikely to hold legal weight, according to Ms Sprecher. The doctor also allegedly billed the patient at a semi-private rate typically associated with inpatient hospital treatment, even though the operation was carried out on an outpatient basis.
Swiss tariff-protection rules prohibit doctors from charging higher prices for treatments covered by mandatory health insurance simply because they consider official reimbursement rates insufficient.
The controversy is attracting political attention in the canton of Zurich. The cantonal parliament has passed a motion calling on the government to ban additional fees designed to secure faster treatment. Given the growing number of complaints the issue deserves closer scrutiny. This is about transparency in the healthcare system, said a patient advocate.
Salaried hospital surgeons in Switzerland typically earn between CHF 180,000 and CHF 300,000 a year. Senior consultants and chief surgeons often receive between CHF 300,000 and CHF 500,000, with some earning substantially more.
What patients can do
Legal experts and patient groups advise patients not to make cash payments without a receipt;
to request written documentation of any additional services; to report questionable demands to cantonal medical authorities, patient associations or doctors’ organisations. Under Swiss law, treatments covered by compulsory health insurance are subject to fixed tariffs that doctors are generally not permitted to exceed.
More on this:
SRF article (in German)
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