The Zurich Children’s Hospital and the Wetzikon Hospital are in financial difficulties. Two years ago, the Affoltern and Uster hospitals were threatened. Hospitals in Bern, St. Gallen and elsewhere are also recording deficits of millions.
Why are the hospitals so in deficit? And what would you have to do? Health economist Tilman Slembeck explains it.
SRF News: Where is our health system “creaking”?
Tilman Slembeck: The problem is the responsibility vacuum. The collective bargaining partners are responsible in many areas. These are the medical profession, the service providers and, on the other hand, the health insurance companies. They have to come to an agreement. But on many issues they cannot do this because there are conflicting interests. If the pie doesn’t grow forever, distribution conflicts arise and things become difficult. We don’t have a health law in Switzerland that regulates such things.
We have to get to a structure in which there are fewer hospitals.
So that’s what’s causing the system?
Naturally. Every canton has a health law, except the federal one. He has an insurance law. It’s like making agricultural policy with hail insurance.
Hospitals are becoming more and more financially strained. What is the main problem, regardless of legal basis?
A deliberate system cleanup is underway, in which resources have been reduced. The cantons can no longer approve what they want through flat-rate funding. The hospitals can no longer cope with this.
The right thing would be for the municipalities to take over the regional hospitals. They would have the benefits, but would also have to bear the deficits.
How to solve this problem?
We have to get to a structure in which there are fewer hospitals. But that doesn’t mean fewer treatments or beds, but rather that there is no longer a small-scale structure that is both expensive and – from a medical perspective – not of good quality.
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The hospital in Wetzikon is in financial difficulties.
KEYSTONE/Christian Beutler
For Slembeck, regional hospitals are generally not very efficient, are small in size and therefore relatively expensive. They would have to compete with other regional hospitals for the scarce staff and the lack of healthcare professionals. Ultimately, it is also very difficult for smaller hospitals to provide medical services because they do not have enough cases. “As a result, they are subject to structural change,” says Slembeck. They would have to merge into larger, more efficient units in order to be able to work more cost-effectively.
But people don’t want fewer hospitals.
Because they haven’t had to pay it yet. The right thing would be for the municipalities to take over the regional hospitals. They would have the benefits, but would also have to bear the deficits. People could decide at the ballot box whether they want to keep their hospital.
Hand on heart: Have we solved the problem in 15 years?
Predictions are difficult and I hate making them. But I think the cantons have enormous perseverance as long as they are so heavily involved financially and they are the main owners of the hospitals. Around 80 percent of hospitals are publicly owned. That’s why I don’t see any big change in 15 years. We need to move to a new system in which the cantons play a much smaller role. I don’t see that at the moment.
The redistribution bills are bad because they do not address the cause, but rather the symptoms.
What does it take for this?
Less money. As long as there is so much money in the system, there are no incentives. All players earn well in today’s system, except the premium payers, who will complain about the next premium increase in the fall and scream in the media. After all, it is one of Mr. and Mrs. Schweizer’s biggest concerns. But this needs to escalate a lot more before real change takes place.
So we’ll be doing the same interview with each other in 15 years?
If the premiums don’t rise massively again and such devastating redistribution bills aren’t adopted. We are voting on two proposals this year and at least one is about taking the pressure out of the boiler and distributing it differently. That’s why these templates are so bad, because they don’t address the cause, but rather the symptoms. If we vote yes, the pressure on the system would decrease and we would still be here in 35 years.
The interview was conducted by Pascal Schumacher.