Fight against premium explosion – National Council wants to slow down increase in premiums with cost targets – News


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Cost and quality targets are intended to curb premiums: National Council recommends rejection of the cost control initiative.

In the fight against rising healthcare costs and the consequences for premium payers, the National Council hammered in further stakes on Wednesday.

After a nearly six-hour debate spread over two days, a narrow center-left majority decided on an indirect counter-proposal to the center party’s “Cost Control Initiative” and recommended it to the people by 156 to 28 votes to reject.

Health Minister Alain Berset can also be satisfied with the solution, as the Council, contrary to his commission, anchored cost and quality goals in the law. The middle achieved a partial success, even if their request in the National Council had no chance.

New cost and quality targets

In the future, the Federal Council should set cost and quality targets for the services for the following four years after hearing all stakeholders in the healthcare system. Every canton can use it as a guide and do the same.

Cost brake initiative and counter-proposals – that’s what it’s all about


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It’s all about this: Healthcare costs have risen by an average of between 4 and 5 percent in recent years, which is reflected in rising health insurance premiums. The center party wants to curb these costs of their initiative: If these rise significantly more than wages, the Federal Council and the cantons must adopt concrete measures. These would have to take effect in the following year so that – according to the aim of the initiative – the premiums remain affordable.

This is controversial: The Bundesrat shares the concern, but opposes this proposal. It is too rigid and could lead to rationing. The Federal Council is therefore presenting an indirect counter-proposal – with more flexible cost targets (originally part of the second cost containment package). In it, the Federal Council proposes an annual maximum target for the costs of basic insurance and apportions this to the cantons. These in turn break it down by area – so that there are maximum cost targets for the hospital, medical practices, laboratories, physiotherapy and so on. If these are exceeded, all those involved should check when and which measures would make sense.

This is the current status: The proposals are now coming to parliament for the first time, to the National Council. However, it does not stop with initiative and indirect counter-proposal. Because the responsible commission rejects the initiative and presents its own counter-proposal – without cost targets. She wants to curb cost growth with tariff interventions, especially for doctors and laboratories – who are supposed to agree contractually cheaper tariffs with health insurers. More applications will follow.

This decision was very narrow on Tuesday with 94 votes to 91 and one abstention – and it also came about because several SVP members were absent during the vote. Center, SP and Greens voted for the cost targets. On the losing side were SVP, FDP and GLP.

Pressure on Tarmed reform

The losing factions argued that the supply could suffer from statutory cost targets. The Federal Council and the centre-left countered: The solution does not provide for any automatism, according to which treatments should no longer be carried out as soon as the cost target is exceeded.

In contrast to the Federal Council, however, the National Council did not want to specify what would happen if the cost targets were exceeded. In such a case, the government would examine measures – such as adjusting collective agreements.

More power for health authorities

To this end, the National Council decided that the increase in costs in compulsory health insurance should be slowed down with further specific measures in tariffs and laboratory analyses.

For example, the Federal Council should immediately reduce excessive, inappropriate and non-economic remuneration in the Tarmed tariff structure for outpatient medical treatment. In the future, the tariff approval authority should also be able to lower tariffs for certain specialists or improve the situation for basic suppliers in certain regions.

The right tariff

The Greens prevailed with a minority motion with 105 to 74 votes. Katharina Prelicz-Huber (Greens / ZH) said that excessive tariffs would have to be adjusted as well as those that were too low in order to avoid false incentives. After all, up to 50 percent of the success of the treatment depends on adequate care. The correct classification is initially supposedly more expensive, but cheaper in the end, for example if outpatient treatment is possible instead of the profitable operation.

The initiative and counter-proposal now come before the Council of States. The initiative “For lower premiums – cost control in the health care system” (cost control initiative) should also have no chance there. It demands that the Federal Council, the Federal Assembly and the cantons intervene if the cost growth per insured person is one fifth higher than the nominal wage development.

In two weeks, the National Council will debate the popular initiative “Maximum ten percent of income for health insurance premiums” (premium relief initiative)” of the SP.

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