Harold Ph.Eisner M.D
Physician and Surgeon
The financing of out-patient medical care
In Switzerland there are different providers of re-imbursment.
The optimal amount of money to cover medical cost is certainly not anymore available.
In Switzerland someone is sick form an illness and then medical cost are covered under the LAMAL until proved that he is suffering from an injury and then covered by the LAA (the injury may or may not be work related without difference in coverage).
Some people working for international organisation are covered outside the Swiss system.
In both the LAMAL and the LAA there is a concept of economicity, which mean what is done should be economically validated. The control of this concept is done by the insurances themselves.
Traditionally the economicity concept does not belong the European medicine.
In case of conflict anyone has to prove his claim against the assertion of the insurances which be a though job.
Regarding the accident insurance LAA :
To be recognized as accident the medical condition should come from a external force, suddenly sustained, involuntary sustained and unexpected.
This is a definition from a lawyer point of view. It should be proved beyond reasonable doubts.
In case of accident covered by the LAA, the patient is free to go to the provider of his choice.
Form some specific article please refer to the text in French.