Executive Summary

The system change in psychological psychotherapy in Switzerland (since 1 July 2022) is predominantly assessed as successful by patients and professionals. The referral practice works well, and access to therapy has tended to improve. However, costs charged to mandatory health insurance (OKP) have risen in three years from 528 million francs (2021) to 922 million francs (2024) – an increase of 75 percent. The Federal Council took note of this evaluation on 24 June 2026 and intends to continue cost monitoring.

Persons

  • Federal Council (collectively)

Topics

  • Health policy
  • Mental health
  • Health insurance
  • Healthcare costs

Clarus Lead

The massive cost increase presents decision-makers with a dilemma: The new referral model has demonstrably improved access to psychological therapy and is accepted by professionals – yet financing is coming under pressure. With nearly 45 percent of cost growth attributable to factors not directly observable (such as shifts from supplementary insurance), this points to hidden demand effects. The Federal Council responds defensively with enhanced monitoring rather than structural measures – a signal that cost control and service improvement are in conflict.

Detailed Summary

Before the system change (until June 2022), psychological psychotherapists either worked under medical supervision (delegation model) or operated privately in the supplementary insurance and self-pay sector. The new referral model enables them to work independently and directly at the expense of mandatory health insurance on medical referral. The goal was to improve access and ensure quality.

The evaluation conducted in 2025 is based on surveys of therapists, psychiatrists, general practitioners, and patients. Results: The referral practice has become established, and the number of licensed therapists has increased significantly. However, waiting times remain long, particularly in child and adolescent care and in rural regions. The shortage of specialists and rising demand further complicate the care situation.

Regarding the cost explosion: Approximately 30 percent of growth results from higher tariffs, nearly 25 percent from long-term trend of rising demand and population growth. The remaining 45 percent arises from factors not directly measurable – primarily the shift of privately paid and supplementary insured services into mandatory health insurance. The evaluation report identifies optimization potential in cost approvals and psychiatric case assessments for longer therapies.

Key Findings

  • The system change is predominantly assessed as successful by professionals and patients; the referral practice is well-established.
  • OKP costs have risen by 394 million francs (75%) in three years; nearly half of the increase cannot be directly explained.
  • Waiting times remain long, especially for children/adolescents and in rural areas; the shortage of specialists remains a structural problem.

Critical Questions

  1. Data Quality: How representative are the evaluation surveys? What sample sizes and response rates were achieved, and how were selection biases excluded?

  2. Causality of Cost Increase: The 45 percent of "factors not directly observable" constitute a residual category. What specific mechanisms are suspected (e.g., overdiagnosis, incentive effects from the referral model, catch-up effects)?

  3. Conflicts of Interest: To what extent have psychotherapists, whose income has risen under the new model, influenced the evaluation? Were independent external evaluators employed?

  4. Feasibility of Controls: The report mentions "optimization potential" in cost approvals. What concrete measures does the Federal Council plan, and how will these not jeopardize care quality?

  5. Equitable Provision: While waiting times in rural regions remain long, costs have risen centrally. How does the Federal Council plan to address regional disparities without driving up new costs?

Sources

Primary Source: Federal Council – Evaluation of psychological psychotherapy: System change successful, cost increase observed – https://www.news.admin.ch/de/newnsb/InNuMMG44_5LuF8ztcpg3

Verification Status: ✓ 24.06.2026

This text was created with the support of an AI model. Editorial responsibility: clarus.news | Fact-checking: 24.06.2026