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The uniform financing of outpatient and inpatient services is considered a winner. But “EFAS” could still fail.
Health care costs are constantly rising and premiums are high. After years of blockade and mini-reforms, Parliament is now on a bigger project: all health services should be financed equally – regardless of whether they are provided at home by Spitex, in the hospital or in the doctor’s office.
The idea, which is already 14 years old, is now entering the final parliamentary curve. But changes also raise fears: patient and consumer protection organizations have reached parliament. In a letter available to SRF, they ask that the reform be rejected because the switch to uniform financing would make premiums even more expensive. The health insurance association santésuisse is also critical of the reform.
The reports have clearly shown that EFAS does not result in an increased burden but rather a reduced burden.
During the debate about uniform financing, or EFAS for short, the Council of States was very aware that the reform could still fail. But health politician Erich Ettlin (center) waved this aside: “The reports have clearly shown that there is no additional burden with EFAS, but rather a reduced burden.” The premium burden should therefore decrease noticeably in just five years, as the cantons will now contribute to all costs.
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The EFAS health care reform aims at a change to uniform financing of health services.
Keystone/Gian Ehrenzeller
Today it matters where someone is treated: in the hospital with an overnight stay, the cantons and health insurance companies share the costs roughly in half. Without an overnight stay or in the practice, the bill goes to the cash register and is fully reflected in the premiums.
Fewer disincentives
In care – whether at home or in a nursing home – things are different again. This leads to false incentives, which the reform aims to eliminate. Hannes German (SVP/SH) emphasizes that the boundary to care is completely fluid and is therefore rightly viewed from a single source: “So there are no false incentives to keep people in the hospital longer or to throw them out as quickly as possible.”
In the future, cantons and health insurance companies should participate everywhere – the cantons with around 30 percent, the health insurance companies with around 70 percent. Over 20 health associations welcome the reform. These include the FMH;Spitex, the hospitals and nursing homes as well as the health insurance association curafutura.
Referendum threat
Pressure from Parliament is also coming from the unions, which are threatening a referendum. The VPOD fears that the inclusion of nursing will increase the pressure on staff. Hegglin warned: “Nothing would be gained if the bill comes through parliament with a maximum solution for the cantons, but then runs aground before the people.”
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Councilor of States Ettlin for compromises: “It cannot be assumed that the National Council will give its own position everywhere. Then the crash would most likely be the result.”
Keystone/Peter Klaunzer
Hegglin tried to forge a compromise on two controversial points and to accommodate the National Council, which had already included care in principle in the proposal: But the Council of States stuck to its stance that those being cared for would continue to have to make a contribution to the care costs. The National Council wanted to transfer this entirely to the cantons. According to the Council of States, this would be additional costs of half a billion francs.
Hegglin also voted for a longer transition period until care is included in the uniform financing. The National Council makes the implementation of the care initiative a condition for this. But here too, the Council of States insisted on its position. This makes the starting point for the reform project unpredictable. It now goes back to the National Council. The aim is to reach an agreement before Christmas.