Why is speech therapy a paramedical field
In terms of costs, speech therapy plays a subordinate role in social health insurance. For the past two or three years, the annual gross benefits in the area of compulsory health insurance (OKP) have only been between 5.5 and 6 million francs. Nevertheless, speech therapy has its rightful place among paramedical therapies. The following sentence is on the homepage of the German-speaking Swiss Association of Speech Therapists (DLV): «So that language becomes a matter of course». ...Continue reading "
In terms of costs, speech therapy plays a subordinate role in social health insurance. For the past two or three years, the annual gross benefits in the area of compulsory health insurance (OKP) have only been between 5.5 and 6 million francs. Nevertheless, speech therapy has its rightful place among paramedical therapies.
The following sentence is on the homepage of the German-speaking Swiss Association of Speech Therapists (DLV): «So that language becomes a matter of course». This says what is meant by the term speech therapy. Speech therapists help people who suffer from speech impairments (“voice, speech and language disorders”). The aim of speech therapy is to regain or improve language skills in children, adolescents and adults.
Speech therapy in the KVG
Speech therapists treat on medical orders. Their services are not mandatory services of the OKP, except in the cases listed in Art. 10 of the Health Care Service Ordinance (KLV), which can be traced back to:
- organic brain damage with an infectious, traumatic, post-operative, toxic, tumor or vascular cause;
- Phoniatric disorders (pathological phenomena in speech and voice formation), for example caused by a harelip, i.e. a partial or total deformity of the lips, palate and jaw or disorders of the mobility of the tongue and mouth muscles or the soft palate with infectious, traumatic or surgical-postoperative cause, etc. (cf. Art. 10 KLV).
The services are only reimbursed by the health insurer if the self-employed speech therapists who work on their own account can prove that they meet the legal requirements in accordance with Article 50 of the Ordinance on Health Insurance (KVV) and that the insured person is entitled to benefits.
Scope of services according to KVG
The health insurers assume the costs of a maximum of 12 sessions within 3 months of the doctor's order at the expense of the OKP for each medical prescription. A new doctor's prescription is required to take over further sessions. Long-term treatments, i.e. more than 60 one-hour sessions within one year, also require a report and a reasoned proposal on the continuation of the treatment from the treating doctor to the medical examiner of the responsible health insurer. The latter will review the proposal and ask whether and to what extent the speech therapy can be continued at the expense of the health insurer. The attending physician has to report to the medical examiner at least once a year about the course and the further indication of the therapy.
The speech therapists are free to choose the advisory and treatment methods within the framework of the medical prescription, the statutory provisions and their specialist knowledge, provided that they pay the necessary attention to the requirement of effective, economical and appropriate treatment (Art. 32 and 56 KVG). With regard to the number of sessions and the type of treatment, you are obliged to limit yourself to what is necessary for the purpose of the treatment and which is in the interests of the insured person (Art. 56 para. 1 KVG).
What does speech therapy cost?
For every 15 minutes of individual therapy, a speech therapy treatment and examination, i.e. all related work and instructions for continuing the treatment at home, currently costs between CHF 20.30 (Canton Ticino) and CHF 21.85 (Canton Zurich). In the vast majority of the cantons, CHF 20.70 is charged for speech therapy and examination. Speech therapy, which is carried out in groups, costs between CHF 23.40 and CHF 25.20 per 15 minutes. The therapeutic preparation and follow-up will be charged in addition to the individual therapy.
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I've been in the social health insurance sector for over 34 years. In addition to my tasks as an expert in the service purchasing department at tarifsuisse ag and as a representative of tarifsuisse ag in various equal commissions.
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