Palliative care

What is palliative care?

Palliative care covers the care and treatment of people with incurable, life-threatening or chronic progressive diseases. That is how the Federal Office of Public Health (FOPH) describes it. The aim is no longer a cure but the best possible quality of life in the time that remains: relieving pain and other symptoms, preventing complications, and supporting the person concerned and their relatives. Besides medical treatment and nursing care, it includes psychological, social and spiritual support.

The FOPH distinguishes between general and specialised palliative care. General palliative care is provided by GPs, home care organisations (Spitex), nursing homes and hospitals as part of their normal work. Specialised palliative care is intended for situations in which the symptoms are complex or unstable; it takes place, for example, on the palliative care wards of hospitals.

For health insurance, the key point is this: palliative care is not a separate branch of insurance or a separate benefit item. Basic health insurance pays for the individual services needed in a palliative situation under the same rules as for any other illness. However, the Federal Health Insurance Act (KVG) expressly obliges the Federal Council to take into account the care needs of people who require palliative care when specifying nursing care benefits (Art. 25a para. 3ter KVG).

Palliative care must be distinguished from assisted suicide. Assisted suicide is not a health insurance benefit and is not covered on this page.

How it works

Medical treatment, medicines and aids

Basic health insurance covers examinations and treatments by doctors, whether outpatient, in hospital or in a nursing home, as well as medicines on the List of Pharmaceutical Specialties (SL) prescribed by a doctor and items on the Aids and Appliances List (MiGeL) (Art. 25 para. 2 KVG). This also applies to pain therapy and treatments that serve only to relieve symptoms, as long as they meet the criteria of effectiveness, appropriateness and cost-effectiveness (Art. 32 KVG).

Nursing care at home by Spitex

Basic health insurance covers nursing care at home if there is a demonstrated need for care and the care has been prescribed by a doctor (Art. 25a para. 1 KVG). Care is provided by self-employed nurses or by home care and nursing organisations such as nursing care at home (Spitex). The services are listed exhaustively in Art. 7 KLV and divided into three groups:

The contributions are set out in Art. 7a para. 1 KLV and are billed in units of 5 minutes, with a minimum of 10 minutes. Coordination in complex and unstable care situations may only be provided by specialised nurses with two years’ experience of interdisciplinary cooperation (Art. 7 para. 2bis KLV). In palliative care in particular, this coordination between the GP, Spitex, pharmacy and relatives is often essential.

A doctor’s instruction for examination and treatment services is valid for no more than nine months and can be renewed; for people receiving a helplessness allowance for moderate or severe helplessness, it is valid indefinitely (Art. 8 KLV).

Nursing home and hospital

In a nursing home, basic health insurance pays for the same nursing care services as for care at home (Art. 50 KVG), with a daily contribution graded by care needs in minutes: from CHF 9.60 for up to 20 minutes to CHF 115.20 for more than 220 minutes of care per day (Art. 7a para. 3 KLV). Basic health insurance does not pay for board, lodging and personal assistance; if your income is low, supplementary benefits can help.

If you have to go to hospital because your condition suddenly worsens, for example to a palliative care ward, you are insured in the general ward of a listed hospital, as with any hospitalisation (Art. 25 para. 2 let. e KVG). After a hospital stay, acute and transitional care prescribed by a doctor can be paid for up to two weeks under the rules of hospital financing (Art. 25a para. 2 KVG).

Legal basis

There is no separate federal act on palliative care. For financing through health insurance, the following provisions apply:

• Art. 25 KVG: general benefits in case of illness, including medical treatment, medicines, aids and appliances, and hospital stays in the general ward.
• Art. 25a KVG: contributions to nursing care provided on an outpatient basis, in day or night care facilities and in nursing homes (para. 1), acute and transitional care (para. 2), consideration of palliative care when specifying benefits (para. 3ter), and the limit on the patient’s share to no more than 20% of the highest nursing care contribution, with the canton financing the remaining costs (para. 5).
• Art. 50 KVG: in a nursing home, the insurer pays the same benefits as for outpatient nursing care.
• Art. 7, 7a and 8 KLV: exhaustive list of nursing care services, contributions per hour and per day, the doctor’s instruction and how long it is valid.
• Art. 64 KVG: the deductible and retention fee also apply here.

The financing of long-term care therefore spreads the costs across three parties: health insurance, the insured person and the canton. Each canton regulates the details of the residual financing itself.

Example: four weeks of palliative care at home

Margrit is 78, lives at home with her husband and is terminally ill. Her GP prescribes Spitex care. Each week, Spitex provides 5 hours of basic care, 2 hours of treatment care (medicines, monitoring the pain pump) and 1 hour of assessment, advice and coordination. The contributions are taken from Art. 7a para. 1 KLV.

If she has to go into hospital, basic health insurance pays for the stay in the general ward; Margrit also pays a hospital contribution of CHF 15 per day (Art. 104 KVV).

What this means for you

1. Plan early. Talk to your GP about palliative care before a crisis occurs. A doctor’s instruction for Spitex care is required for basic health insurance to pay.
2. Check your deductible. With a serious illness, high costs are foreseeable. A low deductible then reduces your own share. You can only switch to a lower deductible with effect from 1 January; your notification must reach the insurer by 30 November. The premium calculator shows the comparison.
3. Ask your canton. How much patients contribute to nursing care and which services are available depend on the canton and the municipality.
4. Look at supplementary insurance. Some supplementary insurance policies contribute to household help or personal assistance. The insurer profiles under health insurers show which insurers offer which benefits. However, new supplementary insurance usually requires you to answer health questions.
5. Check supplementary benefits. If your pension and assets are not enough to cover nursing home costs or personal assistance, you may be entitled to supplementary benefits.

Common mistakes

• Thinking palliative care is not insured. Basic health insurance pays for the medical and nursing care services as for any illness.
• Starting nursing care without a doctor’s instruction. Without an instruction or prescription, there is no entitlement to contributions from basic health insurance.
• Confusing personal assistance with nursing care. Keeping someone company, shopping or cooking are not nursing care services under the KLV. These costs fall to you, to a supplementary insurance policy or to other bodies.
• Letting the instruction expire. An instruction for treatment care is valid for no more than nine months. Have it renewed in good time.
• Assigning the whole nursing home bill to the insurer. In a nursing home, the insurer pays only for nursing care. Board and lodging appear on a separate bill.

How we calculate with amounts taken from the law and ordinances is explained under how we calculate.