2024 - Health costs - pressure to save makes the politically taboo topic of hospital mergers socially acceptable

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Despite discussions about excess capacity, hospital mergers rarely occur. This was rejected in Basel-Stadt and Baselland in 2019, but now voices are being heard for a new attempt.

On average, health insurance premiums will be eight percent more expensive by 2024. This gloomy prospect increases the pressure to save on everyone involved. One approach would be to reduce hospital beds or to merge or close hospitals.

Four years ago, Basel-Stadt and Basel-Landschaft wanted to merge their cantonal hospitals for the first time – and ventured into the hospital merger minefield. Both are sponsors of the University of Basel, and the Basel University Hospital (USB) would have been merged with them. “Would be”, because the merger failed in the city canton in 2019; the rural canton said yes.

Important reasons for the no vote in Basel-Stadt to the merger of the cantonal hospitals in 2019 were left-wing concerns about working conditions and mistrust because of the hospital stock corporation with unequal shares: the city canton should have injected more money.

Just five years earlier, Baselland had clearly rejected the first steps towards a possible reunification of the two cantons, which had been separated since 1833, at the ballot box. Basel-Stadt had accepted this proposal. This political slap in the face continues to have an impact.

Hospital list for both Basels

In 2019, however, coordinated health planning in the form of a common hospital list was adopted in both Basels. Since then, the two cantons have shared treatment areas permitted by health insurance companies – which is intended to avoid overcapacity.

How well this curbs costs is still unclear. Basel city health director Lukas Engelberger points to evidence: “We see that inpatient hospital treatments are developing more moderately than outpatient ones, which we do not plan.”

Just four years later, the Basel hospital merger is now back on the political table: A hospital merger could strengthen basic care and reduce costs, says Basel SP National Councilor Sarah Wyss. It would therefore be “an important sign that this hospital merger is being tackled again”.

The former National Councilor of the SP Susanne Leutenegger-Oberholzer from Basel is also hoping for a new attempt at the hospital merger, as she recently said in a TeleBasel panel discussion. Sitting next to her was Basel FDP Grand Councilor Luca Urgese, who agreed: “It’s certainly something you have to look at.”

The last time a major hospital merger was successful was in 2021 with the cantonal hospitals of Lucerne and Nidwalden. The Obwalden Cantonal Hospital now also wants to come under this network umbrella. And in 2017, the cantons of Uri, Schwyz and Zug combined their entire basic psychiatric care.

In some cases, the pressure to save continues even after hospital mergers. The Berner Insel Group, which emerged in 2016 from a merger of the university hospital with regional hospitals, is closing two locations and centralizing its operations.

The St. Gallen hospitals, which are making serious losses, are already cooperating in associations and are now to be completely merged. The merger is intended to utilize even more synergies and thus save costs.

Bankrupt vulture is circling

Infrastructure costs often cause problems for hospitals; sufficient funds for investments are difficult to obtain. Aargau had to save its cantonal hospital from bankruptcy with 240 million because it had run into difficulties due to construction projects.

The Uster Hospital is also threatened with bankruptcy if the sponsoring municipalities do not contribute 40 million. Plans to merge with Wetzikon Hospital, which is only ten kilometers away and will soon be moving into a new building, were canceled in 2020.

The Basel FDP district administrator Sven Inäbnit does not rule out a new attempt at a hospital merger between the two Basels per se. But in view of the financial challenges and the trend of “outpatient over inpatient” he primarily insists on a broader discussion, also with a view to the neighboring cantons of Solothurn and Aargau.

However, the Basel city health director Lukas Engelberger gives little chance to a new hospital merger attempt. The best solution for this was on the table in 2019.

Basel is oversupplied.

For health economist Heinz Locher, there is a need for action in both Basels: “Basel is oversupplied.” However, a hospital merger is not the best approach – there is a risk of emotions and arguments.

Instead, Locher suggests discussing facts openly: how many hospitals the Basel region really needs. This is also an emotional discussion, as he admits: In St. Gallen and Vaud, health directors were voted out because they wanted to close hospitals.