The health benefits of prevention are widely accepted, yet most preventive measures aren’t covered by basic health insurance in Switzerland, creating significant barriers to wider adoption. Against this backdrop, we spoke to Nicolas Loeillot, who works in business model and innovation development at the CSS Group, a Swiss health insurance leader. He offered a forward-looking perspective on how prevention could become a more integral and economically viable part of the Swiss healthcare system.
 
What’s the insurer’s stance on preventive healthcare?

From my perspective, prevention should be viewed as a key part of the future of healthcare – we need to stop getting bogged down in the constraints of today’s system. After all, for an insurer like CSS, prevention represents an opportunity to improve health outcomes and extend our role beyond traditional insurance activities.

In this, I’m not just talking about the traditional idea of prevention – i.e. encouraging people to exercise, avoid smoking or adopt healthier lifestyles. While those measures are valuable, their impact is difficult to measure directly. A more actionable form of prevention revolves around improving the quality of care itself: for example, ensuring that a patient recovering from surgery does not return to hospital because of complications. This type of preventive measure directly contributes to better outcomes, as well as reducing unnecessary costs.

Indeed, as I see it, the insurer’s role – especially in basic insurance, which is a not-for-profit system based on solidarity – is to help people avoid unnecessary visits to the doctor or hospital, while ensuring that those who genuinely need care receive it. By honing their approach to prevention, insurers can help create a healthcare system that is more proactive, efficient and focused on long-term outcomes.

What, if any, preventive healthcare measures are currently reimbursed by insurers? What could be the impact of offering a wider range of preventive measures?

The Swiss system is complicated and highly fragmented, with around 40 health insurers offering different approaches. The extent of coverage depends on the insurer and the type of insurance.

Still, speaking broadly, there are two main levels of coverage: basic insurance and supplementary health insurance. Basic insurance covers essential healthcare services when you’re sick or injured, but generally not prevention: this is offered through supplementary insurance. Notably, increasing the preventive healthcare services offered through supplementary plans is becoming a focus area for many insurers, as it’s an opportunity to develop new business models, as well as play a more active role in managing healthcare outcomes, rather than just reimbursing treatment after illness occurs.

The demand from customers is there too: more and more people are prioritising preventive healthcare measures, as they enable earlier detection of underlying health risks, support more personalised care and help people avoid unnecessary healthcare interventions.

What concrete actions is CSS taking or planning to take to become an active player in the preventive healthcare space?

We’ve started offering a range of supplementary insurance plans that each customer can personalise according to their respective needs and priorities. Our main vehicle for prevention is the Livo range, which includes dedicated prevention cover. It contributes to health check-ups and screenings, travel and protective vaccinations, and courses such as first aid and stress management. Customers pay an additional monthly premium and gain access to reimbursement for these services.

Alongside this, we offer plans focused on encouraging healthier lifestyles. Through Active365, customers with CSS supplementary health insurance earn rewards for positive behaviours such as regular physical activity or following nutrition tutorials, which can then be exchanged for benefits such as fitness subscriptions or healthier lifestyle products.

But beyond these individual initiatives, we’re also exploring a broader shift towards integrated care models. Inspired by pioneering organisations such as Kaiser Permanente – a managed care consortium headquartered in California – CSS is actively developing networks that bring together insurers, hospitals, general practitioners, pharmacies and other healthcare providers under one roof. The aim is to create a more holistic view of each patient, enabling earlier intervention, better coordination of care and more effective prevention.

Can you tell us a bit more about this model where hospitals and insurers work together on preventive healthcare?

As I said, CSS is currently piloting integrated care across various locations in Switzerland. We have seven integrated networks up and running today, and three more will be added before the end of the year, which will bring us to ten.

The model essentially revolves around shared processes and data flows, as well as collective responsibility for patient outcomes. Each complex patient is assigned a dedicated point of contact – normally a specialised nurse – who helps coordinate and monitor treatment pathways. This creates continuity of care as well as allowing providers to identify risks earlier and prevent avoidable hospital visits.

Another element widely discussed in this context is financial incentives. Under a model called capitation, rather than reimbursing each treatment individually, providers work with a fixed budget per patient, which shifts the focus from the volume of care delivered to the quality of the outcome. It’s designed to encourage coordination and to avoid unnecessary readmissions, in part by making better use of patient data and expertise across an integrated ecosystem. Personally, I believe incentive models of this type are the future of prevention.

How can insurers encourage the adoption of innovations that support prevention (e.g. wearables, early diagnostics, at-home monitoring)?

As I see it, we’re a sort of bridge between emerging technologies, healthcare providers and patients. That’s why we’ve developed initiatives like the Future of Health Grant, in partnership with EPFL Innovation Park, which identifies promising start-ups and tests their solutions in our integrated care networks to measure the impact on prevention and cost reduction. CSS also invests in healthcare start-ups through our corporate venture capital arm, SwissHealth Ventures, with the aim of bringing effective innovations onto the market.

Still, there’s a challenge around connecting consumer technologies with clinical care. Many popular wearables are not certified medical devices, making it difficult for hospitals to integrate their data into patient care. Start-ups have an important role to play in transforming consumer-generated data into solutions that healthcare providers can use.

How would you like the health insurance landscape to look in 20 years?

In my view, the system of the future should be built around better use of data, stronger collaboration and more integrated care. Today, healthcare data in Switzerland is extremely fragmented: different institutions hold separate datasets and exchange of information is limited. Better standardisation and networking between the actors of the system is needed – right now, that’s the main hurdle to greater data exchange. Breaking down these barriers would enable more accurate predictions, better decision-making and more effective prevention.

Looking further ahead, and provided questions of consent and data protection are properly settled first, one can imagine insurers and providers working together on targeted prevention programmes. For example, if shared data were to indicate an elevated risk of a condition such as osteoporosis, an early intervention could be offered to slow its progression. That’s a direction worth exploring, it’s not something we do today.

We also need to be clear-eyed about how we manage resources. Healthcare costs in Switzerland, and with them mandatory insurance premiums, have been rising by several percent a year, well above general inflation. That trajectory isn’t sustainable in the long term. Of course, the goal isn’t to restrict access to care when people need it, but we need to reduce unnecessary interventions, duplication and waste. The regional care networks CSS supports – coordinating the whole chain of caregivers from general practitioners through hospital, rehabilitation and residential care – represent a pioneering initiative which is already showing encouraging early results.

Ultimately, we need to build a healthcare system based on data, transparency and accountability that improves outcomes while reducing unnecessary costs. Only then will preventive healthcare become economically viable at scale.