Zurich asks the neighboring cantons to pay. They should make up for the deficits in the treatment of their Covid-ill citizens in Zurich hospitals. But it is doubtful whether such deficits exist at all.
Anyone who is in a Covid 19 intensive care unit generates very high costs. Whether these are covered or not is debatable.
If a hospital has many corona patients, this can become a financial risk. At least that’s what the Zurich Health Department claims. It is based on figures according to which there is a deficit of 2113 francs per day of treatment for a person affected by Covid 19 in the intensive care unit. This in so-called Covid-A hospitals, which take care of the complex cases. With a stay of two to four weeks at the IPS, that would result in a hefty minus of 30,000 to 60,000 francs. On the normal ward, on the other hand, the average additional costs for corona patients are only CHF 18 per person per day.
In mid-January, the Zurich government provided CHF 21 million so that Zurich hospitals can cover their deficits with local corona patients. At the same time, she has made it clear that she is not prepared to plug the financial gap for patients from outside the canton herself. These make up around 10 to 15 percent of those hospitalized with Covid. Especially at the University Hospital (USZ), many Covid 19 sufferers with severe courses who live in a neighboring canton are treated. Finance director Ernst Stocker cried to the canton of Schwyz: “I could also reduce taxes if I had practically no hospital costs.”
Zug and Graubünden generously, others not
The government council asked the hospitals to invoice the costs directly to the relevant cantons. As the “CH Media” newspapers report, Zug and Graubünden have so far transferred money to Zurich. Schwyz and Aargau only confirm that they have received an invoice, but remain silent about the amount – and also about their willingness to assume the treatment costs of their residents.
A clear answer, however, comes from the east: “The canton of Thurgau will not pay the bill,” says Health Director Urs Martin (svp.). The USZ had asked Thurgau to transfer 233,000 francs. But there is no legal basis for this, Martin complains. The law only stipulates that the canton of residence must bear 55 percent of the treatment costs (the health insurance company pays the rest). Martin relies on the so-called tariff protection: Hospitals could not calculate any further remuneration beyond the flat rate per case. The law does not allow additional invoices.
The people of Zurich also know that they have no legal leverage. They therefore rely on appeals for solidarity. Jörg Gruber, deputy head of the Health Office, told the NZZ: “We see the other cantons as sharing responsibility and have a factual data basis to be able to reach agreements with them.”
Irritation in the neighboring cantons
Gruber complained that the Zurich hospitals were losing several million Swiss francs in the current omicron wave alone. And announced that the Health Office and the Finance Directorate would seek talks with the neighboring cantons to find a solution. The fact that the bill from the USZ flutters into the house first causes irritation in some cantons.
Ideally, the treatment of Covid 19 patients would not get the hospitals into financial difficulties in the first place. The Zurich government council is therefore calling for the tariff structure to be adjusted so that the hospitals receive enough money for the patients in their intensive care units. However, the SwissDRG, which is responsible for the further development of the flat rate per case, doubts that the existing tariffs cause a shortfall at all.
The SwissDRG has determined that in 2020 the billed services for corona patients covered 107.6 percent of the costs, for non-corona patients it was almost exactly 100 percent. The balance sheet for the severe cases that made a stay in the intensive care unit necessary is somewhat worse. But there is no systematic underfunding in this area either, on the contrary.
SwissDRG AG tried to react quickly to the pandemic in 2020, for example with special remuneration for intensive care with mechanical ventilation, emphasizes SwissDRG Managing Director Simon Bäumer. “We tended to overcorrect. That means: The Covid cases were retrospectively slightly overpaid compared to all other inpatient cases in 2020 in most of the affected tariff groups. »
Half of the costs uncovered?
The discrepancy is obvious. In addition, the alleged deficit of over 2,000 francs per IPS day in the canton of Zurich appears very high when you make comparisons. The University Hospital Basel estimates the costs for 25 days of Covid-19 intensive care at over 100,000 francs. That amounts to a good CHF 4,000 per day. And half of it is supposed to be uncovered in Zurich?
At the USZ, it is said on request that there are many Covid patients with a high degree of severity in the hospital, who are very complex to treat. “These are often on the IPS for a very long time and generate higher costs.”