Disabled people accuse the IV of being too stingy with aids and that the insurance stands in the way of integration in school and in the job.
Little Livio (right) needs special shoes to accommodate his orthosis. The IV only finances three pairs per year – far too few for an active boy, his parents think.
Before her stroke of fate struck, Isabelle Danioth was very active. The woman from central Switzerland jogged, hiked, cycled and did fitness. Then she injured her cruciate ligament. Her knee became inflamed, the connective tissue proliferated excessively (arthrofibrosis), and the joint became increasingly stiff. From 2017 onwards, Danioth could only walk with crutches. Over the years, the situation worsened so much that an amputation was necessary in February 2023.
Isabelle Danioth lost the battle for her right lower leg. But her battle with the disability insurance (IV) was only just beginning.
Short sprints thanks to the prosthesis
An orthopedic specialist recommended a high-tech prosthesis called Genium X3 to Danioth. This was developed in collaboration with the US military and would enable Danioth to do many things that other prostheses cannot: she would be able to swim, climb stairs relatively easily and change pace quickly. Even short sprints are possible, according to the manufacturer.
Danioth was able to try out the prosthesis and was delighted. She felt safer on uneven ground than with other products and had less back pain. And she is convinced that she also needs the Genium X3 prosthesis for her new job: the former cook, who had to give up her job before the amputation because of knee problems, wants to become a social worker. In August she started an internship in a Kriens prison.
Danioth’s doctor Frank Klenke states in a report why his patient needs the Genium X3 prosthesis: As a social worker, she will make home visits. She will probably work with children or a therapy dog. This “absolutely” requires a prosthesis that enables rapid changes in movement.
But the Obwalden IV office responsible for Danioth sees things differently. In July 2023, it refused to cover the costs. A Genium X3 prosthesis can only be covered in exceptional cases for the purpose of integration. This type of prosthesis is not “simple and practical” for a job as a social worker. This criterion has been defined by the Federal Social Insurance Office (FSIO). In a circular from 2006, it states: The insured person has “no right to the best possible care in the individual case”.
The Genium-X3 is considered one of the best prostheses on the market – but this high-tech device also comes at a price.
The simpler prosthesis would be much cheaper
In February, the IV office wrote again that the offer was not “simple and practical”, but commissioned an assessment with “various prosthetics”. This is still ongoing – and so Isabelle Danioth has not given up hope. One problem is obviously the high cost of a good 60,000 francs for the high-tech prosthesis. The IV only wants to pay for a prosthesis that is about half as expensive, but also has significantly fewer functions.
Danioth is frustrated by how difficult the process is. “People accuse me of insisting on a luxury solution, but that’s not what I’m after.” She doesn’t want to have to live on an IV pension for the rest of her life, but wants to be fully active in her professional life, says the 30-year-old. “But the system makes this difficult for me.”
FDP National Councillor Andri Silberschmidt also criticises the federal government for saving on the wrong people. “Short-term cost optimisation leads to higher costs in the long term, which can be avoided,” says the Zurich resident. He demands that the IV should enable people to lead as independent a life as possible.
Silberschmidt reports on another case that he knows about. It involves a retired man who is in a wheelchair and whose disability insurance refused to replace his broken stair lift. The reason given was that the lift leads to his home office, which he no longer needs as a pensioner. “Such decisions are unrealistic,” says Silberschmidt.
«Striking» conditions
In a 2016 motion, the current president of the Green Party, Balthasar Glättli, called for social insurance to cover the costs of “optimal” aids for people with disabilities. He said that in Switzerland, people who are significantly restricted in their everyday lives are denied an improvement in their quality of life for purely financial reasons is “shocking”.
The Federal Council warned that the solidarity of the whole towards the insured persons should not be overstretched. This would no longer be guaranteed if subjective criteria such as “optimality” were included. In other words: those affected could make maximum demands and the manufacturers could demand higher prices. The National Council clearly accepted Glättli’s motion in 2018, but a year later the Council of States rejected it.
Daniel Zweifel is the managing director of the orthopedic company Spiess and Kühne and vice president of the Ortho Reha Suisse (ORS) association, which represents around a hundred companies. He says that the industry is inventing ever better products, particularly in the area of prostheses – such as the Genium X3. “Of course, our customers want the best aids available. This and the prescribed ‘simple and practical’ solutions create a conflict.”
Only a fraction of IV expenditure
Zweifel points to Germany, where “optimal” care is guaranteed by law. He wonders why something like this is not possible in wealthy Switzerland. Especially since aids such as prostheses, hearing aids or wheelchairs are a relatively small item. In fact, at around 200 million francs per year, they only make up about 2 percent of the IV budget.
Another source of frustration for orthopedic companies is that it often takes a very long time for the approval process to be completed – as was the case with Isabelle Danioth. In more than half of all cases, the sixty-day deadline for approval of costs is not met, according to industry sources. This means that service providers have to wait a long time for their invoices to be paid.
Danioth is not the only one affected who finds IV practices to be laborious and petty – this is particularly evident in the case of less expensive aids such as those needed by Livio Roth*, who lives with his parents in a village in the Zurich wine country. He is a person who loves to move, says his mother Martina. But the eight-year-old has a handicap: he suffers from muscle stiffness due to a prenatal cerebral infarction.
Heavy wear on the shoes
He needs an orthosis to stop himself from tripping all the time. The IV pays for this medical device, which supports his right leg, without any problems. The problem is the special shoes that Livio needs because the orthosis widens his foot. According to the IV’s medical device regulations, insured persons are entitled to two pairs of special orthopedic shoes per year. “That might be enough for a child who is in a wheelchair – but never for an eight-year-old who is running around all the time,” says Livio’s mother.
Livio loves sports – even though he always comes last because of his disability.
It is important to her that her son can grow up as normally as possible despite his disability. “He is enthusiastic about school sports, even if he always comes last.” And Livio is also in the youth gymnastics club. His parents therefore applied for funding for a third orthopedic shoe, a trainer.
The negative response from the responsible IV office states briefly: “Shoes that are needed for leisure activities (including school sports) cannot be covered by disability insurance.” If parents are experiencing financial difficulties, they should contact Pro Infirmis or another advice center.
A pair of special shoes for Livio costs 500 francs, which is no small sum for his parents.
“That’s just not right”
This answer annoyed Livio’s parents. “That’s just not right,” says his mother. It must be clear to the IV that it is best for Livio’s health in the long term if he moves as much as possible. “And he will also be much better integrated socially if he can go to gymnastics and youth club.”
For the parents, it’s a matter of principle, but not only that. A special shoe costs around 500 francs. “That’s not a small price for us, we can’t just afford it,” says the mother. Her husband earns a simple wage and she can only work part-time because of her son’s disability. And Livio also has three siblings.
When asked by the NZZ, the responsible IV office referred to the federal regulation, which leaves no room for maneuver. Several months have passed since the visit to Weinland. In the meantime, the Roths have found out that they can apply for a third special shoe per year when a child is growing. “But even that is still very tight,” says the mother.
Best possible and most modern solution
Those responsible at the Federal Social Insurance Office reject the accusation of pettiness. The word “simple” can be misunderstood in relation to the aids, says Raphael Tschanz, a specialist in aids. This should be understood to mean that aid components that have no influence on the integration goal but are based on an explicit customer request are not covered by the IV – for example, if it is only a matter of aesthetic factors. “In Switzerland, however, those affected get the best possible and most modern solution from the IV if the need is proven and the care is appropriate.”
Whether an aid is appropriate must be determined in each specific case. If a person with a leg amputation only wants to take a few steps in their own home every day, a leg prosthesis with the most expensive electronic knee joint is probably not appropriate, says Tschanz. For a geologist who often works in rocky terrain, however, it might be.
According to Tschanz, especially with electronic arm or leg prostheses, the question arises as to whether a person is physically and mentally capable of controlling such a complex device and using its functions. “That requires a lot of discipline and practice. We want to avoid an expensive device ending up in the corner.”
Tschanz does not deny that in some cases IV clients have to wait a long time for their costs to be approved. There can be various reasons for this and it can happen, for example, if an assessment is particularly complex, if there is a shortage of staff at an IV office or if those affected are unable to undergo the assessment for psychological reasons – for example, shortly after an amputation. Tschanz can neither confirm nor deny whether the majority of cases really take more than sixty days to review, as representatives of the industry claim: the BSV does not have any corresponding statistics.
In a Communiqué from June The Federal Council promises that, as part of the next IV revision, it will lay the foundations for the IV, but also the AHV, to be able to provide insured persons with “the most technologically advanced and appropriate aids possible”.
* Names changed by the editors.
