Berset forces insurers and doctors to stay in detention

229,397 francs: If there were something like a standard doctor, then this would be his annual “reference income” in this country. At least that’s how the doctors’ association FMH and the health insurance association Curafutura see it. Together they have developed a proposal for a new tariff for outpatient medicine, which was discussed again in the Federal Council on Friday. One of the bases of the extensive work is the reference income, which is intended to show the gross salary including employer contributions.

Now, however, the federal experts find that this income is a bit high. This is one of many reasons why the Federal Council still does not want to approve the new tariff. Health Minister Alain Berset and his colleagues fear an unjustified increase in costs if they approve the Tardoc, as the controversial work is called.

The test report by the Federal Office of Public Health (BAG), which was also published on Friday, shows how far the concerns go. This shows that the calculation of the reference income is based on the average wages of hospital doctors. From the Federal Government’s point of view, this is not appropriate. According to the BAG report, the proposed reference income would be a good 10 percent higher than the current tariff.

It’s about 12 billion francs

However, the Federal Council did not definitively reject the new tariff on Friday, as some of those involved had feared. Berset expressly emphasized that the proposal is a good basis. This must now be further improved by the end of 2023 in order to be able to be introduced after all. Berset emphasized several times that the Federal Council was very interested in an agreement.

Because the situation is bad. Today’s tariff, the Tarmed, has been in force since 2004. Payments of a good 12 billion francs from basic insurance continue to run through him, although the underlying structure is now hopelessly outdated. Although this is recognized by all interest groups, they have not been able to pull themselves together and work out a common proposal for a new solution. Above all, the other health insurance association, Santésuisse, vehemently rejects the Tardoc, also for fear of a cost hike. The hospitals are also on the sidelines, but have recently shown themselves willing to talk. They could be living with an improved Tardoc by now. Both sides, Santésuisse and the hospitals, would prefer to work with flat rates in the future.

The Federal Council, in turn, would prefer it if all collective bargaining partners could jointly agree on a solution. So far, however, his appeals have had little fruit. There was no lack of mediation attempts. A compilation by the department of Berset shows that the Minister of Health has held three round tables with all stakeholders in recent years. There were also numerous meetings between the BAG and collective bargaining partners.

Federal Council increases cost pressure

And yet the Federal Council is not giving up hope – not least because it has no alternative. However, the homework he gave the Tardoc partners on Friday goes a long way. They are likely to lead to unpleasant discussions, especially among doctors: the Federal Council is increasing the cost pressure. One can read his decisions in such a way that, from his point of view, the Curafutura funds have accommodated the doctors too far in the previous negotiations. Among other things, they have agreed that additional costs of up to 3 percent will be accepted in the first few years without tariff cuts being implemented. The Federal Council is now demanding that this upper limit firstly be guaranteed and secondly reduced to 2 to 2.5 percent. In addition, the deal should also include mandatory monitoring that records long-term cost trends.

Another point of criticism appears several times: The BAG complains in various areas that Curafutura and FMH do not base relevant values ​​in the Tardoc on effective, verifiable data, but on expert opinions, among other things. The collective bargaining partners have made efforts in this regard, but the BAG is still not satisfied. A note in the BAG report gives an idea of ​​how difficult the cooperation between doctors and insurers is in terms of transparency: “It should also be noted that the FMH unfortunately only made certain documents available to the BAG, but Curafutura did not receive them.”

The rules of the game changed several times

Shortly after the media conference of the Federal Council, the Tardoc partners presented their point of view. They were bitterly disappointed with the decision. There is talk of a “black day, damaged trust and a health policy shambles”. FMH and Curafutura accuse Berset and his experts of having changed the rules of the game several times. A year ago, the Federal Council did not complain about the additional costs of up to 3 percent. Pius Zängerle, director of Curafutura, said that the demanded limitation of cost growth to a maximum of 2.5 percent was never communicated to the collective bargaining partners.

They also criticize that they had heard nothing from the federal government since the amendments submitted at the end of 2021 until the government’s decision on Friday. The collective bargaining partners would at least have expected to be able to comment on the Federal Council’s remaining points of criticism beforehand. Between the lines one can read the accusation that Federal Councilor Berset might not be interested in the introduction of the Tardoc because he kept increasing the hurdles.

On other points, statement stands against statement. According to the Federal Council, the introduction of the new tariff will not remain without cost consequences, as requested, but will lead directly to an increase of at least 123 million francs. The FMH representative Urs Stoffel contradicted: This is not correct. Changing the tariff model would not incur any additional costs.

What bothers one person pleases the other

FMH and Curafutura left open on Friday whether they will improve the Tardoc to meet the Federal Council’s conditions. The decision will be analyzed and further action will be discussed. However, they indicated that they would not slam the door too quickly. For the two partners, there is no question that it can only be a matter of improving the Tardoc that has been submitted.

Santésuisse, the second health insurance association, sees this completely differently. He was relieved about the Federal Council’s decision. This paved the way for an outpatient tariff that would be worked out jointly by all tariff partners. Santésuisse was not involved in the Tardoc negotiations.

In turn, Curafutura and FMH do not want this. Santésuisse’s attitude leads back to square one, said Zängerle. It would take five to eight years for a new outpatient tariff to be developed and negotiated.

The positions of the collective bargaining partners are still miles apart after this round. The Federal Council’s appeal to the collective bargaining partners to work together remains a pious wish.