Psychotherapy: Online coaching is booming, but who should pay?
Psychotherapy via app is booming – but who pays for it?
Experts see great potential in online tools for strengthening mental health. But so far, users have often been stuck with the costs.
Online coaching promises relief: more and more people affected by psychological stress are seeking help on the Internet.
Photo: Getty Images
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Depression, eating disorders, panic attacks: There are many reasons to seek help from a psychologist. However, some practices have long waiting listsFeelings of shame can also prevent those affected from making an appointment with a specialist.
Online coaching promises to provide a solution. They advertise with slogans such as: “Psychological support exactly when you need it” or “no waiting times”. As research shows, such offers are booming in Switzerland.
The Swiss portal Aepsy, for example, arranges video sessions with trained psychologists and therapists using a matching algorithm. The company reports a sharp increase in user numbers: The number of coaching sessions tripled from 2022 to 2023 and grew strongly again in the first quarter of 2024. Several thousand sessions are booked every year.
With other offers, users click through exercises independently and are accompanied by experts via chat. This type of online therapy is offered by Hellobetter, which offers programs to combat burnout, sleep problems and panic disorders. This program is also experiencing “increasing growth” in Switzerland.
“Potential is far from exhausted”
The health care system is closely monitoring developments. The Sanitas health insurance foundation has just published a report examining how the population feels about such offers.
In the representative survey with over 2,000 participants, 40 percent said they had felt “moderately to severely mentally stressed” in the last four weeks – the proportion is even higher among the younger generation. However, only a small proportion of those surveyed have had experience with online tools to strengthen mental health.
Almost half could basically imagine using such offers. The potential is therefore “far from exhausted,” according to a statement about the study.
This also looks Felix Gutzwiller so. The former Zurich FDP Council of States member and preventive medicine specialist was president of the Sanitas Foundation for nine years, and resigned from office a few days ago. He says: “We know from health promotion that digital tools can have a positive effect on addiction problems, for example.”
Gutzwiller is convinced that sensible use of such tools could relieve the system. “If people with mild symptoms can be helped easily digitally, psychotherapists have more capacity to deal with severe cases.” The bottom line is that the tools are likely to have a cost-cutting effect, he believes.
Other countries are leading the way
Today, basic insurance pays for video sessions with psychotherapists under certain conditions. Other types of online coaching are generally not reimbursed – or at most are reimbursed by additional insurance.
If it were up to Thomas Berger, this would have to change. The head of the Department of Clinical Psychology and Psychotherapy at the University of Bern has been researching digital health applications for many years. He says: “Originally, it was assumed that online tools could be useful primarily for mild symptoms. But now we see good examples of application for almost all disorders.”
“Switzerland would do well to follow the example of other countries”: Thomas Berger, head of the Department of Clinical Psychology and Psychotherapy at the University of Bern.
Photo: Alessandro della Valle (Keystone)
Berger is not primarily thinking of offers where the patient and psychologist sit face to face in front of a screen. He is interested in so-called self-management tools, where those affected complete their exercises largely independently. A specialist clarifies beforehand whether the program is suitable for the person in question. Depending on the model, contact is then made via chat or email at certain times.
Berger explains: “If someone suffers from anxiety disorders, for example, an app like this can provide very good information about how critical situations arise. Exercises help to gradually overcome fears.” Of course, there are cases in which this type of treatment is not an option – for example in cases of suicidality. In principle, the results are promising. Studies have shown that a combination of online and offline therapies is often more effective than psychotherapy alone.
Berger points out that other countries are already using these options much more naturally than Switzerland. In Germany, digital tools can be prescribed by prescription if they meet certain quality criteria. In the UK, many people with depressive symptoms only go to a psychologist after guided self-management coaching has failed. The system works very well, says Berger. “Switzerland would do well to follow these countries’ example.”
Health insurance companies refuse
Not all psychotherapists think this way. But the Federation of Swiss Psychologists (FSP) is not resistant to the trend – quite the opposite. Spokesman Florian Näf says: “We definitely see potential in the fact that such tools can effectively complement psychotherapy in the traditional sense.” This is the case, for example, in the case of long waiting times, but also between two therapy sessions or to prevent relapse. It is clear that patients should not be left to bear the costs alone.
However, financing through basic insurance does not currently seem to have majority support in Switzerland. In the survey conducted by the Sanitas Foundation, only a minority are in favor of it. The health insurance association Santésuisse is also critical. Spokesman Matthias Müller points out that the range of services has already been expanded significantly since psychologists were able to bill for their services directly through basic insurance.
“Today there are more psychiatrists and psychotherapists working in a practice than there are general practitioners and pediatricians.” The costs would have increased by 300 within a year increased to almost 800 million francs. This puts a lot of strain on the insured, says Müller. “We currently do not see how this trend can be counteracted by remunerating additional services – such as apps or similar digital tools.”
Some health insurers apparently see this differently. Health insurance companies such as Helsana, Sanitas and Swica actively offer their policyholders online self-help training. “We see a lot of potential in this coaching and are working to make this offer even more widely known,” says Helsana. Swica is even “trying to find a financing basis for this in the basic insurance,” says a spokesperson. Initial discussions with the Federal Office of Public Health are already underway.
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