Harmonizing Innovation and Regulation: Swiss Health Insurance

Navigates Digital Health Technologies for Enhanced Patient

Engagement

Estelle Pfitzer

1,5 a

, Birte Jörn

and Tobias Kowatsch

1,3,4 b

School of Medicine, Universität St. Gallen, St. Gallen, Switzerland

Corporate Venture and Innovation, Sanitas, Zürich, Switzerland

Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland

Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland

MTIP Ag, Basel, Switzerland

Keywords: Digital Health Technologies, Health Insurance, Care Support, Health and Wellness.

Abstract: We investigate the innovative domain of digital health technologies (DHTs) within the unique and highly

regulated context of the Swiss health insurance system, focusing on the pragmatic approach adopted by

Sanitas, a leading health insurance provider in Switzerland. Drawing on an insightful interaction with Birte

Jörn, manager for innovation and venturing at Sanitas, the following position statement underlines the

strategic integration and adoption of DHTs to enhance customer engagement, reinforce patient self-

management, and, subsequently, mitigate healthcare and insurance service costs. Among barriers such as

rigorous regulations and reimbursement limitations, insights collected from various DHT pilot programs

unveil certain tendencies, like notable customer interest in DHTs oriented towards lifestyle, mental well-

being, and chronic disease management.

1 INTRODUCTION

The Swiss health insurance system represents a

unique model that combines universal coverage with

a regulated competitive market. Rooted in ensuring

healthcare access for all, every resident living in

Switzerland for more than 3 months must have basic

insurance coverage (Obligatorische

Krankenversicherung, 2022.). This coverage is

standardized, offering essential health services to

everyone, irrespective of their socio-economic status

(Marks-Sultan et al., 2016). The Swiss healthcare

system operates in a highly decentralized manner,

each of the 26 cantons has distinct health legislations

and plays a crucial role in healthcare provision, from

emergency services to hospital planning, and is a

significant source of public financing (Maurer et al.,

2022).

In this context of a regulated competitive market,

digital health technologies (DHTs) emerge as a

https://orcid.org/0009-0006-0577-2757

https://orcid.org/0000-0001-5939-4145

promising avenue for health insurance providers in

Switzerland to differentiate themselves. By

leveraging DHTs, such as clinical information

systems, digital preventive care interventions, patient

monitoring services, care support technologies,

digital diagnostics, or digital therapeutics, insurers

can enhance patient engagement and potentially

reduce healthcare costs.

For instance, a chronic disease management

platform can empower patients to manage their

conditions more effectively, reducing the need for

frequent doctor or hospital visits (Jacobson et al.,

2023; Kowatsch & Fleisch, 2021; Kvedar et al., 2014;

Wang et al., 2023). When integrated into the broader

healthcare ecosystem, such DHT can improve patient

outcomes and create a more sustainable healthcare

system (Benis et al., 2021; Digital Implementation

Investment Guide (DIIG): Integrating Digital

Interventions into Health Programmes, n.d.). It is

difficult to calculate long-term cost implications of

digital health technologies when incorporating broad

Pﬁtzer, E., Jörn, B. and Kowatsch, T.

Harmonizing Innovation and Regulation: Swiss Health Insurance Navigates Digital Health Technologies for Enhanced Patient Engagement.

DOI: 10.5220/0012368300003657

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 17th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2024) - Volume 2, pages 833-837

ISBN: 978-989-758-688-0; ISSN: 2184-4305

833

considerations, such as costs of the technology

lifecycle and those to integrate technology into the

clinical workflow (Mathews et al., 2019). However,

in their literature review assessing the cost-

effectiveness of digital health interventions, Gentili et

al. found that 32 out of 35 studies demonstrated gains

in Quality-Adjusted Life Years (QALYs), with most

also reporting notable cost savings (Gentili et al.,

2022a).

Figure 1: Average Monthly Healthcare Expenditure per

Swiss Household (Household Expenditure | Federal

Statistical Office, n.d.).

The increase in healthcare costs per household is

evident when comparing data from 2010 to 2020, as

depicted in Figure 1. During this decade, households

experienced a rise of more than 100 CHF per month

in their healthcare expenditures. Interestingly,

expenses associated with supplementary health

insurance remained relatively stable throughout these

years. Conversely, other healthcare costs

encompassing medication, dental services, and

laboratory analyses have seen a decline. The primary

contributor to the escalation in expenses is the

obligatory health insurance, which has shown a

pronounced uptick. This trend emphasises the

importance of leveraging DHT to mitigate healthcare

expenses (Gentili et al., 2022b).

Sanitas, founded in 1956, is one of Switzerland's

leading health insurance companies covering basic

and supplementary health insurance. To gain insight

into the perspective of Swiss health insurers regarding

digital health, this position paper outlines the results

of a conversation with Birte Jörn, manager for

innovation and venturing at Sanitas. Questions

focused on Sanitas' implementation of DHTs,

specifically whether they are utilized for prevention

or disease management, and if these were developed

internally or through external collaborations. The

conversation also touched upon the strategic aims of

deploying DHTs, including revenue generation, cost-

efficiency, and customer loyalty. Additionally, we

explored Sanitas' experiences and outcomes with

various DHTs, seeking insights into their relative

effectiveness and areas for improvement.

2 POSITIONING STATEMENT

DHTs encompass various technologies and

methodologies to improve healthcare delivery,

outcomes, and personal wellness. While it primarily

serves patients, DHTs also help a wide array of other

stakeholders in the healthcare sector, like healthcare

professionals and hospital administrations, with

operational and clinical software systems (Keasberry

et al., 2017). For patients, DHTs can be broadly

classified into five main categories. The first category

is health and wellness solutions, designed to promote

overall well-being and proactive health maintenance

(Thai et al., 2023). These DHTs are complemented by

the second category, patient monitoring technologies,

emphasizing real-time health metrics tracking (Le

Goff-Pronost & Bongiovanni-Delarozière, 2023).

Third, care-supporting technologies facilitate disease

management and self-management. Furthermore,

digital diagnostics harness technology for early

detection and diagnosis of diseases, ensuring timely

treatment (Parikh & Helmchen, 2022; Vasudevan et

al., 2022). Finally, digital therapeutics offer

technologically driven treatment to directly address

health concerns (Jacobson et al., 2023; Wang et al.,

2023).

Sanitas has not developed or is directly offering

any DHTs with clear medical purpose and relevant

medical certification. Since, as an insurance

company, they cannot prescribe medication.

However, more lifestyle-oriented applications in the

category health and wellness for prevention are of

great interest to health insurers but also the most

challenging area due to very limited possibilities for

reimbursement. It is also difficult to reach and engage

the low socioeconomic status population with

preventive solutions, although they suffer from the

most non-communicable diseases and would benefit

from these lifestyle DHT solutions the most

(Kowatsch et al., 2019).

8.5%

9.0%

9.5%

10.0%

10.5%

11.0%

11.5%

100

200

300

400

500

600

700

800

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Portion of revenue spent on Healthcare

Average Monthly Healthcare Expenditure (CHF)

Obligatory Health Insurance

Supplementory Health Insurance

O the r H ealt hca re Cost s

Portion of revenue spent on Heal thcare

Scale-IT-up 2024 - Workshop on Emerging Business Models in Digital Health

834

While medical doctors mainly oversee disease

management, Sanitas employs a deliberate strategy to

engage with DHTs and enhance customer experience

and offers solutions covering different categories:

1. Non-Health system software solution:

Sanitas provides a portal accessible via a web

browser or mobile application, enabling

customers to manage their insurance details

autonomously. The Sanitas Portal offers a

comprehensive coverage view, facilitates

reclaim voucher scanning, and highlights

exclusive health offers. The mobile application

won second place at the Best of Swiss App

Awards 2022 in both “Business Impact” and

“User Experience & Usability”.

2. Care Support: The insurance as developed its

own mobile applications for care support. They

are not classified as medical devices, like one

featuring a "health navigator,” to disseminate

valuable health-related information. Through a

strategic partnership with Medgate, a leading

telemedicine provider specializing in remote

consultations and digital health services,

customers can address medical inquiries using a

digital assistant and directly access Medgate

doctors for teleconsultations or appointment

bookings via the Sanitas Medgate app.

3. Health and Wellness: Sanitas offers a white-

labelled app for individuals managing chronic

conditions. The Sanitas Digital Health Coach

addresses widespread issues such as stress and

unhealthy living, which can culminate in

conditions like high blood pressure and type 2

diabetes. The interactive platform enables users

to evaluate vital health metrics, such as heart age

and diabetes risk, through self-tests but also

ensures meticulous tracking of key health

parameters like blood pressure and sleep data via

a health diary. Furthermore, the coach provides

actionable and medically substantiated

recommendations, aiding users in navigating

their health data toward actual health

improvements. Coupled with timely reminders

for medications and health measurements, the

Sanitas Coach promotes a sustainable transition

towards healthier living.

4. Recommendations on DHTs: In addition to the

above, Sanitas gives recommendations and links

to other DHTs for specific customer journeys,

guiding clients toward beneficial digital

resources. In collaboration with leading DHT

startups, Sanitas suggests the following:

- Aepsy: A Swiss platform connecting users

with selected psychotherapists through

online chat, video telephony, or in-person

meetings.

- Pathmate Technologies: An online

platform designed for individuals with

chronic diseases, offering personalized

healthcare management and coaching.

- TOM: A mobile application that provides

medication reminders to assist users in

maintaining consistent medication

regimens.

- Pregnolia: A company that has developed

a technique to predict the risk of premature

birth. Notably, Sanitas is the first health

insurer in Switzerland to cover the

Pregnolia test for those with

supplementary outpatient insurance (Stone

& House, 2023).

2.1 Strategic Objectives

As DHTs evolve, Sanitas pursues a strategy that

aligns with multiple, well-defined goals. Firstly, the

company aims to enhance customer loyalty by

delivering pertinent and engaging offerings. This

involves providing digital tools that empower patients

to actively manage their health (Iglesias et al., 2018).

This strategy fosters self-management and can reduce

overall medical costs (Awad et al., 2021).

Additionally, a calculated shift towards a self-service

model for insurance-related queries and processes

supports Sanitas' approach. This move enhances

customer convenience by simplifying interactions

and reducing costs related to insurance services.

Overall, offering DHTs enhances the appeal of health

insurance for patients, enabling them to manage their

health and potentially lower their medical costs and

health insurance expenses.

2.2 Challenges and Insights

Exploring the deployment of DHTs presents

challenges and insights for Sanitas. Significant

barriers have surfaced through various pilots of

DHTs. The main challenges identified are limited

reimbursement options and targeted customer

engagement (Reinhardt, 2004). Despite access to

extensive customer data, strict sector regulations

significantly limit targeting opportunities within the

customer base.

While deriving a one-size-fits-all success pattern

is complex due to variables like usability, customer

age, and cost, certain tendencies emerge. For

Harmonizing Innovation and Regulation: Swiss Health Insurance Navigates Digital Health Technologies for Enhanced Patient Engagement

835

instance, DHTs aiming at prevention, health, and

well-being, such as general fitness or mental well-

being applications, show the highest Sanitas customer

interest. It is also observed that DHTs for chronic

patients, e.g., medication adherence apps, generate

big interest, especially when integrated into a frame

program (overarching healthcare management and

support strategy) by the insurance company. This

underscores that embedding DHTs within a well-

orchestrated, structured program enhances patient

utilization, amplifying its viability and impact.

3 CONCLUSION

Navigating the challenging path of DHT

implementation, Sanitas combines strategic adoption

with encountered hurdles and important insights

within the strictly regulated Swiss health insurance

framework. The journey clearly shows DHTs’ vital

role in increasing customer loyalty, helping efficient

disease self-management, and potentially reducing

costs while being influenced by various impactful

variables like usability and customer demographics.

The balance between technological progress and

regulatory and operational alignment emerges as

crucial, paving the way for synergistic advancements

in patient outcomes and operational efficacy within

the structured competitive market. Future

explorations may focus on ensuring that regulatory

frameworks are flexible and evolving to foster the

development and integration of emerging DHT

pertinent to health insurances, technological

improvements like increasing interoperability among

different health care stakeholders, and forming

strategic alliances with promising DHT companies.

DHT hold significant potential for reducing

healthcare costs, benefiting health insurance

providers. However, a standardized metric for

evaluating cost-effectiveness is essential and still

needed to identify the most financially impactful

solutions within the Swiss healthcare system.

4 CONFLICT OF INTEREST

EP and TK are affiliated with the Centre for Digital

Health Interventions (CDHI), a joint initiative of the

Institute for Implementation Science in Health Care,

University of Zurich, the Department of

Management, Technology, and Economics at ETH

Zurich, and the Institute of Technology Management

and School of Medicine at the University of St.

Gallen. CDHI is funded in part by CSS, a Swiss

health insurer, the Swiss growth-stage investor MTIP,

and the Austrian health provider Mavie Next. TK is

also a co-founder of Pathmate Technologies, a

university spin-off company that creates and delivers

digital clinical pathways. However, CSS, Mavie

Next, or Pathmate Technologies were not involved in

this research. EP works at MTIP, a Swiss healthtech

growth equity firm that helps founders scale up

successful and sustainable digital health businesses.

REFERENCES

Awad, A., Trenfield, S. J., Pollard, T. D., Ong, J. J.,

Elbadawi, M., McCoubrey, L. E., Goyanes, A.,

Gaisford, S., & Basit, A. W. (2021). Connected

healthcare: Improving patient care using digital health

technologies. Advanced Drug Delivery Reviews, 178,

113958. https://doi.org/10.1016/J.ADDR.2021.113958

Benis, A., Tamburis, O., Chronaki, C., & Moen, A. (2021).

One Digital Health: A Unified Framework for Future

Health Ecosystems. J Med Internet Res 2021;

23(2):E22189 Https://Www.Jmir.Org/2021/2/E22189,

23(2), e22189. https://doi.org/10.2196/22189

Digital implementation investment guide (DIIG):

integrating digital interventions into health

programmes. (n.d.).

Gentili, A., Failla, G., Melnyk, A., Puleo, V., Tanna, G. L.

Di, Ricciardi, W., & Cascini, F. (2022a). The cost-

effectiveness of digital health interventions: A

systematic review of the literature. Frontiers in Public

Health, 10. https://doi.org/10.3389/FPUBH.2022.787

135

Gentili, A., Failla, G., Melnyk, A., Puleo, V., Tanna, G. L.

Di, Ricciardi, W., & Cascini, F. (2022b). The cost-

effectiveness of digital health interventions: A

systematic review of the literature. Frontiers in Public

Health, 10. https://doi.org/10.3389/FPUBH.2022.7871

Household expenditure | Federal Statistical Office. (n.d.).

Retrieved October 18, 2023, from https://www.bfs.ad

min.ch/bfs/en/home/statistics/economic-social-situatio

n-population/income-consumption-wealth/household-

budget/household-expenditure.html

Iglesias, O., Markovic, S., Bagherzadeh, M., & Singh, J. J.

(2018). Co-creation: A Key Link Between Corporate

Social Responsibility, Customer Trust, and Customer

Loyalty. Journal of Business Ethics 2018 163:1,

163(1), 151–166. https://doi.org/10.1007/S10551-018-

4015-Y

Jacobson, N., Kowatsch, T., & Marsch, L. (2023). Digital

Therapeutics for Mental Health and Addiction: The

State of the Science and Vision for the Future.

Academic Press. https://www.alexandria.unisg.ch/

handle/20.500.14171/107854

Keasberry, J., Scott, I. A., Sullivan, C., Staib, A., & Ashby,

R. (2017). Going digital: a narrative overview of the

Scale-IT-up 2024 - Workshop on Emerging Business Models in Digital Health

836

clinical and organisational impacts of eHealth

technologies in hospital practice. Australian Health

Review, 41(6), 646–664. https://doi.org/10.1071/AH

16233

Kowatsch, T., & Fleisch, E. (2021). Digital Health

Interventions. Connected Business: Create Value in a

Networked Economy, 71–95. https://doi.org/10.1007/

978-3-030-76897-3_4/COVER

Kowatsch, T., Ford, J. G., Howerton, M. W., Lai, G. Y.,

Gary, T. L., Bolen, S., Gibbons, M. C., & Baffi, J.

(n.d.). How to Lower Socioeconomic Inequalities in

Health with Digital Therapeutics? Healthification-A

Short Animation. https://doi.org/10.3389/fcell.2019.0

0074

Kvedar, J., Coye, M. J., & Everett, W. (2014). Connected

health: a review of technologies and strategies to

improve patient care with telemedicine and telehealth.

Health Affairs (Project Hope), 33(2), 194–199.

https://doi.org/10.1377/HLTHAFF.2013.0992

Le Goff-Pronost, M., & Bongiovanni-Delarozière, I.

(2023). Economic evaluation of remote patient

monitoring and organizational analysis according to

patient involvement: a scoping review. International

Journal of Technology Assessment in Health Care,

39(1), e59. https://doi.org/10.1017/S02664623230025

Marks-Sultan, G., Kurt, S., Leyvraz, D., & Sprumont, D.

(2016). The legal and ethical aspects of the right to

health of migrants in Switzerland. Public Health

Reviews, 37(1), 1–16. https://doi.org/10.1186/S40985-

016-0027-2/METRICS

Mathews, S. C., McShea, M. J., Hanley, C. L., Ravitz, A.,

Labrique, A. B., & Cohen, A. B. (2019). Digital health:

a path to validation. Npj Digital Medicine 2019 2:1,

2(1), 1–9. https://doi.org/10.1038/s41746-019-0111-3

Maurer, M., Wieser, S., Kohler, A., & Thommen, C.

(2022). Sustainability and Resilience in the Swiss

Health System SWITZERLAND. www.phssr.org

Obligatorische Krankenversicherung Individuelle

Prämienverbilligung. (n.d.).

Parikh, R. B., & Helmchen, L. A. (2022). Paying for

artificial intelligence in medicine. Npj Digital Medicine

2022 5:1, 5(1), 1–5. https://doi.org/10.1038/s41746-

022-00609-6

Reinhardt, U. E. (2004). The Swiss Health System:

Regulated Competition Without Managed Care. JAMA,

292(10), 1227–1231. https://doi.org/10.1001/JAMA.29

2.10.1227

Stone, J., & House, M. (2023). Measurement of cervical

softness before cerclage placement with an aspiration-

based device. American Journal of Obstetrics &

Gynecology MFM, 5, 100881. https://doi.org/10.1016/

j.ajogmf.2023.100881

Thai, Y. C., Sim, D., McCaffrey, T. A., Ramadas, A.,

Malini, H., & Watterson, J. L. (2023). A scoping review

of digital workplace wellness interventions in low- and

middle-income countries. PLOS ONE, 18(2),

e0282118. https://doi.org/10.1371/JOURNAL.PONE.0

282118

Vasudevan, S., Saha, A., Tarver, M. E., & Patel, B. (2022).

Digital biomarkers: Convergence of digital health

technologies and biomarkers. Npj Digital Medicine

2022 5:1, 5(1), 1–3. https://doi.org/10.1038/s41746-

022-00583-z

Wang, C., Lee, C., & Shin, H. (2023). Digital therapeutics

from bench to bedside. Npj Digital Medicine 2023 6:1,

6(1), 1–10. https://doi.org/10.1038/s41746-023-00777-

Harmonizing Innovation and Regulation: Swiss Health Insurance Navigates Digital Health Technologies for Enhanced Patient Engagement

837