Palliative physicians are appalled Health insurance companies do not want to reimburse medication for terminally ill patients

Many people want to die at home. Palliative care physicians accompany terminally ill patients on their final journey. End-of-life caregivers complain that important pain-relieving medication is not covered by health insurance companies.

Most seriously ill patients wish to die at home in their familiar surroundings. This is not an easy path for families and relatives. Palliative physicians support people in the last phase of their lives.

Palliative physician Monika Jaquenod-Linder does everything she can to fulfill her patients' last wish. In an interview with theNZZ am Sonntagnewspaper, the dedicated doctor talks about her constant struggle with health insurance companies that do not want to reimburse pain-relieving medication. "We have an enormous administrative burden, and in the worst-case scenario, we're stuck with the costs," says Jaquenod-Linder.

Absurd obstacles in the final battle

She talks about a 50-year-old patient whom she accompanied to her death last year. The woman had a tumor growing on her tongue. She was lovingly cared for at home by her daughter. As the carcinoma spread further and further towards her throat and neck, the patient could no longer swallow. Massive fears of suffocation sent the woman into a panic. In such cases, the experienced palliative care physician administered the powerful painkiller Palladon intravenously. The proven medication reliably relieves the pain.

"For me, this was a crystal-clear case. There were no alternatives and I could no longer stand by and watch the patient suffer," says Jaquenod-Linder. Although Palladon is on the specialty list of the Federal Office of Public Health (FOPH), the health insurance company Atupri refuses to reimburse the drug. All medicines on this list are covered by the compulsory health insurance.

Flimsy justification

The reason given by Atupri is that the drug is only on the FOPH list in tablet form, whereas the intravenous form is not. Of course Jaquenod-Linder would have liked to administer Palladon to her patient in tablet form. However, the tumor on the dying woman's tongue made it impossible to swallow the medication. She therefore injected her with the painkiller. "This is an approved medication that has been tested by Swissmedic. It is not on the list of specialties simply as an ampoule," says the doctor.

Yet the intravenous form of Palladon is an important tool in the daily work of palliative care physicians. In such cases, they must always submit an application for individual reimbursement. If the health insurance company rejects the application, the family or even the palliative care physician must cover the costs themselves. This can quickly add up to several thousand francs if applied for several times.

Woman dies before application is answered

In the case of the patient cared for by Jaquenod-Linder, the health insurance company rejected the application. In a statement to the "NZZ am Sonntag", the insurance company wrote that it was prepared to work with the authorities to improve the situation of people in palliative care. Atupri understands the concerns of the doctors and the patients affected, the press office continued.

Jaquenod-Linder is particularly incomprehensible about another statement made by Atupri. According to the health insurance company, the doctor should have first submitted a funding application to the insurance company before administering Palladon intravenously. Sadly ironic: it took 19 days for Atupri to send the doctor an answer to her request. In the meantime, her patient had already been dead for several days.

Not an isolated case

The case of the intravenous medication described above is not an isolated case in the field of pain therapy by palliative care physicians. As early as 2022, the association submitted a whole list of strong painkillers and sedatives to the federal government, for which there are always problems with reimbursement by the health insurance companies and which are often not paid for by the insurance companies.

It is particularly incomprehensible that these drugs are paid for without any problems when used in hospital via a flat rate per case. In the case of terminally ill patients in nursing homes or at home, however, funding is often blocked by the insurance companies. Those who suffer are all people who receive palliative care outside of a hospital and the relatives who have to pay the costs. The federal government saves considerable costs by caring for the dying in their own homes. After all, it is much more expensive to die in hospital.