CHF 191 against CHF 855. In between lies what your clinic now has to prove.

During an on-site review, FINMA, the Swiss financial market supervisor, came across a number worth remembering. A supplementary health insurer had used its own assessment model to value the hotel services of one night in a hospital’s semi-private ward at CHF 191. It then agreed a price of CHF 855 with the hospital. FINMA published the example in January 2025, without names, to show that many market prices are still well above insurers’ internal reference prices.

For readers outside Switzerland, some context. Basic health insurance is compulsory and covers treatment in the general ward. Semi-private and private cover is bought on top, as supplementary insurance, and it is what pays for the free choice of doctor, the better room and the rest of what a private clinic sells. It falls under a different law and a different supervisor, which is why FINMA is involved at all.

You can read the figure in two ways. As a scandal, which is how most people read it. Or as a question for every private clinic: what exactly does a semi-private patient receive for the difference? A clinic with no precise answer will struggle to get that difference paid in its next negotiation.

What has changed.

At the end of 2020, FINMA set out its expectations on transparency and traceability for supplementary insurance. The Swiss Insurance Association (SIA) turned them into eleven principles for defining, valuing and billing additional benefits. Hospitals must state precisely which services belong to basic insurance and which to supplementary insurance. The deadline expired at the end of 2024, and according to the SIA the renegotiation of contracts ran until the end of 2025. In the final measurement in April 2026, covering about 96% of the market, 94.1% of contracts were compliant. The remaining 5.9% are contract gaps: between those hospitals and those insurers, no valid contract currently applies.

FINMA has stayed strict. In January 2025 it criticised contracts with no clear line between basic and supplementary insurance, doctors’ fees that in some cases remain persistently high, and medical services still billed twice. The requirements explicitly apply to employed doctors and to affiliated doctors who use the hospital for their own patients. Prices that deviate significantly from internal reference prices must be reduced. And FINMA will not authorise new supplementary hospital insurance products unless its requirements can be met in the long term.

For a clinic, this creates a new burden of proof. It used to be enough to be a good house. Today every additional benefit has to be described, valued and documented.

The blind spot: the patient never reads this.

This is where it gets interesting for me. Clinics now describe their additional benefits in more detail than ever, but for the insurer, in contracts and tariff models. The patient who pays for supplementary cover every year sees almost none of it. On many clinic websites, the semi-private page is a photo of a room and the word comfort.

That is a problem, because the policyholder decides whether to keep the insurance and where to be treated. If she does not know what she gets for her premium, she discovers its value in a hospital bed, or never. And if she does not know it, she compares clinics on location and reputation, not on what they actually offer on top.

My position is clear: the additional benefit written into the contract belongs on the website too, in the patient’s language. Free choice of doctor, room, visiting hours, meals, choice of appointment, one named contact person: described concretely, not as adjectives. This is not advertising. It is the same transparency the insurer demands, addressed to the person who pays in the end.

What the contract lists as an additional benefit belongs on the website too.

When there is no contract.

FINMA explicitly mentions a possibility clinics fear: a temporary, or in individual cases even permanent, situation with no contract between insurer and hospital, in the interests of policyholders. At the same time, it states that cover continues regardless of such a contract. Policyholders are entitled to the benefits set out in the terms and conditions of their supplementary insurance. According to the SIA, this situation now affects 5.9% of contracts, and negotiations are ongoing.

French-speaking Switzerland has lived through it. After FINMA’s transition period ended on 1 January 2025, Helsana did not reach agreement with every provider, particularly in Geneva and Vaud, and stated that without a contract, supplementary hospital insurance covers the costs only in part, or not at all. Only with the agreement of June 2025 were the restrictions on semi-private and private wards lifted there. In weeks like those, the phone rings. Patients with a scheduled operation want to know whether they are covered, and the answer depends on their policy, not on the clinic. An up-to-date page on insurance and costs, and a process that tracks cost guarantees and tells patients in time, are no longer a design question. They decide whether the patient stays.

What I would check.

• The semi-private and private pages. Do they say what the patient concretely gets on top, or only adjectives?
• The match with the contracts. Does the website promise something that is not agreed as an additional benefit? Is something missing that is?
• The doctors’ pages. Additional medical services are under the spotlight. Can patients see who treats them and how the free choice of doctor works?
• The insurance and costs page. Current, dated, and with a clear answer on what happens when there is no cost guarantee.
• The cost guarantee process. Who requests it, who follows it up, when does the patient hear? This is where good automation saves days and phone calls.

191 against 855 is not a verdict on private medicine. It is an invitation to name your own value precisely enough for an insurer to assess it and for a patient to understand it. The clinics that do this first on their website will have the better argument in both conversations.

Run a test with a single room. List what a semi-private patient receives on top of the general ward, with concrete names, not adjectives. Then put next to it what your website says about that room.

If the two lists do not resemble each other, an uncomfortable question is waiting: if an insurer had to price that room by reading only your website, what figure would they arrive at? Closer to 191 or to 855?

If you would like me to review your website and your patients’ journey from this angle, start with the Strategic Diagnostic.