Health director Natalie Rickli explains in an interview why a Zurich hospital is being revoked its performance mandates.
“In his criticism, the canton of Thurgau is also about maintaining the structure”: the Zurich health director Natalie Rickli.
Six months ago you threatened the hospitals in Uster and Affoltern and the Adus Clinic with the withdrawal of the service mandates that are vital for the hospitals. You have now reduced the pressure on the hospitals in Affoltern and Uster. Why?
In both cases it was definitely worth the pressure we put on them. Both hospitals had originally submitted applications without reorientation. Thanks to the consultation process, however, we have now been able to achieve decisive improvements.
After an initial shock, Affoltern contacted us very quickly and developed a new concept together with us. Instead of a broad basic care, the hospital now wants to focus on geriatric and palliative medicine. Together with the psychiatric offer, which will continue to be operated and even expanded in Affoltern, we have now found a very good solution.
The Uster Hospital has also presented us with a new concept that we think makes sense. It aims to expand outpatient and reduce inpatient services in the medium term. However, the shortcomings in economic efficiency remain a critical point. The hospital has made initial financial improvements and therefore deserves a chance. Nevertheless, we have given those responsible clear requirements that they must meet by the end of May 2025.
And what do you do if Uster does not meet the requirements?
The consequence may be that we withdraw all or part of the service mandates from the hospital. However, the hospital management now has the necessary time for the transformation process.
In one case you stood your ground, at the Adus Clinic. Why?
The Adus Clinic is active in a very selective area and has a low number of cases overall. It is therefore not relevant to the supply for the canton. Other hospitals can easily take on these cases. These also offer on-call services as well as basic and emergency care and therefore have higher costs than a clinic that largely focuses on lucrative cases.
You are required by law to promote competition. But now you are cutting off the competition by removing a clinic with low costs and good quality from the hospital list and shifting the cases to the big hospitals.
In the canton of Zurich, with 24 acute care hospitals, we still have a well-functioning competition. However, competition does not mean that we simply maintain every small hospital. Ultimately, it’s about making the right decisions for the entire population of Zurich.
What would be the damage if the Adus Clinic continued to exist?
There is no need for the hospital in this region. There is no need for basic care in Affoltern either, which is why we will no longer award the hospital any longer-term performance mandates. It’s also about concentrating the services. Many decentralized units tie up a lot of staff. However, the Adus Clinic is free to continue working, simply with a new concept and without funds from the canton. We are now giving the clinic a transitional period during which those responsible can develop new offers.
Zurich is expanding significantly in rehabilitation. This is not well received in all cantons, and the canton of Thurgau in particular has been critical.
With this criticism, the canton of Thurgau is also concerned with maintaining the structure. The fact is that we are not taking anything away from the canton of Thurgau. We simply want to cover the greater part of the need for rehabilitation in the canton of Zurich, which we are forecasting for the next few years. This is in line with our strategy of increasing rehabilitation close to home and to acute hospitals. And we are convinced that this will ultimately benefit patients.
Incidentally, in Thurgau we have continued to include all service providers that were previously on our hospital list. With the Mammern Clinic, we are even adding a new facility.
Do you fear that you will now get into legal disputes?
Those affected are legally entitled to have the decision of the government council reviewed by a court. This hospital planning is valid for the next ten years. Given this dimension, a few complaints are to be expected.