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Care needs, care levels and care costs in Switzerland

The topic of care needs can sometimes cause some confusion in Switzerland's 26 cantons, as the cantons are free to introduce their own needs assessment systems (Federal Supreme Court ruling of 7 October 2019).

Nursing care services in Switzerland are regulated by the Health Insurance Act (KVG) and the Nursing Care Benefits Ordinance (KLV). The KLV is based on 12 care requirement levels. These are based on the amount of care required per day.

Älteres Paar betrachtet von einer Aussichtsplattform aus die malerische Landschaft der Schweizer Alpen, symbolisch für Pflegebedarf in der Schweiz

Determining the need based on the care levels

The KLV distinguishes between 12 care levels. There are 3 care needs assessment systems for the correct classification of people in need of care:

  • RAI-RUG, RAI-HC classification system: people in need of care are assigned to care expenditure groups

  • BESA system: resident classification and billing system

  • Plaisir: like BESA, based on a service catalog

Private Spitex providers usually determine the need for care using RAI-Home-Care Switzerland (from: Resident Assessment Instrument, RAI).
RAI-HC is an assessment tool for adults, mostly older people, who are cared for and looked after at home by Spitex. The assessment of needs using this instrument guarantees a high quality of care, individually tailored to the needs of the patient. The focus here is on the greatest possible independence and a high quality of life.

This is how inpatient care costs are classified and calculated in the cantons of Zurich and Aargau (as at 01.02.2021):

The care levels are reviewed regularly. The higher the care level, the more time is required and the higher the costs.
At lower care levels, care and support at home, as offered by private care services, is often cheaper than a stay in a home. In addition, Spitex offers customized service packages that are tailored to the individual needs of the person requiring care.

Health insurance benefits for outpatient care costs (as at 01.02.2021)

Who pays for the care services?

The costs are shared by the health insurance fund, patients and the public purse. The prerequisite for this is a doctor's prescription. This applies to all nursing services. Non-nursing services, e.g. washing, cooking, accompaniment to doctor's appointments, etc. must be paid for by the patient.
People in need of care generally pay less for outpatient care services provided by Spitex than for inpatient care. However, the patient contribution, which varies from canton to canton, amounts to a maximum of CHF 23.00 per day. The annual costs incurred can be calculated using a care costs calculator: https://www.comparis.ch/gesundheit/spitex/kosten
We will be happy to advise you in detail on the subject of care requirements and care costs. Please take advantage of our non-binding, free initial consultation.
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