Since July 1, 2022, psychological psychotherapists with the appropriate qualifications have been able to work independently and bill their services via basic insurance. The prerequisite for this is that there is a doctor’s order for the treatment. The new model is also called the arrangement model.

This replaces the delegation model. It required psychologists to be under medical supervision, which meant that they had to work in a psychiatrist’s practice. Only then was the therapy reimbursed by the basic insurance. The delegation model was introduced in 1993 as a transitional solution because at that time there was still no title for psychological psychotherapists that was recognized throughout Switzerland. This title has been available since 2013.

Who can order treatments

Physicians with a federal or recognized foreign qualification in general internal medicine, in psychiatry and psychotherapy, in child and adolescent psychiatry and psychotherapy and in child and adolescent medicine can issue orders for therapy. In most cases, the order will be issued by the general practitioner. It is valid for 15 hours of therapy and can be extended by a further 15 hours following an exchange of information between the medical specialist ordering the treatment and the psychotherapist carrying out the treatment. If the therapy is to be continued beyond this, a cost approval from the responsible health insurance company is required.

Requirements for therapists

Certain prerequisites are required for psychotherapists to be able to work according to the new model. This includes a cantonal license to practice psychotherapy, for which they must be in possession of a federal or a recognized foreign advanced training title in psychotherapy. They also need at least three years of clinical psychotherapeutic experience and they practise the profession independently and on their own account.

What is changing for victim support

The introduction of the order model is also important for the victim support services in both Basel. “We are hoping for more invoicing via the KVG, so that Victim Support will only have to bear the cost price, i.e. the deductible or excess, but no longer the full therapy costs,” says Thomas Gall, Deputy Managing Director of Victim Support Basel. “This also better respects the principle of subsidiarity, which is provided for in the Victim Assistance Act.”

Transitional rules until the end of 2022

Delegated psychotherapy can still be reimbursed by health insurance companies until December 31, 2022. Anyone who works on a delegated basis and does not meet the admission requirements for the arrangement model can still work on a delegated basis up to this point. After that, it is no longer possible to bill therapies via the compulsory health insurance. Specialists who held a cantonal license to practice before the introduction of the directive model can continue to work in the respective canton under their own professional responsibility to a limited extent. However, their services are not reimbursed by health insurance companies.

Enough therapists?

The aim of the new model is to give patients better and earlier access to psychotherapy and close gaps in care. It remains to be seen whether this will happen. “It is not yet clear whether enough therapists will be certified for the arrangement model and whether it will be easier to find a place,” says Thomas Gall. The system change takes time. “At the moment, there is a certain amount of uncertainty among the therapists, doctors, insurance companies and specialist agencies affected. We hope that this will soon be clarified for everyone.”

Further information
Federal Office of Public Health: New regulation of psychological psychotherapy

Federation of Swiss Psychologists: Psychological psychotherapy in basic insurance