With a new financing key, Parliament wants to promote cheaper outpatient treatment. Under pressure from the cantons, the Council of States has also included nursing care in the reform package. However, the costs there will rise sharply in the coming years.
For years, Parliament has been delaying a major reform in the healthcare system. In 2009, the middle national councilor Ruth Humbel called for the financing of inpatient and outpatient services from a single source. Today, operations with overnight stays in hospital on the one hand and interventions in medical practices or outpatient clinics on the other are financed differently. The cantons pay at least 55 percent for inpatient treatment, while outpatient treatment is borne entirely by the premium payers.
An example: An outpatient knee joint reflection costs around 2200 Swiss francs on average. Around 7,400 to 10,200 francs are billed for the same procedure as an inpatient. In the case of outpatient treatment, health insurance fares worse because it has to pay the entire amount. The cantons, on the other hand, save money with every procedure that is carried out without an overnight stay in hospital. This has the paradoxical effect that economically reasonable savings lead to higher premiums.
This analysis was undisputed in the Council of States on Thursday – with the exception of the SP. Paul Rechsteiner sees no false incentives in today’s system. The shift from inpatient interventions to the outpatient sector ordered by the Federal Council has led to lower costs for the cantons and basic insurance. In addition, neither cantons nor insurers could influence the decision of patients and doctors whether treatment should be outpatient or inpatient, said Rechsteiner.
SP and health insurance companies agree for once
The Social Democrats are against the reform for another reason. They fear that the premium payers will have to pay higher costs. Under pressure from the cantons, the Council of States incorporated long-term care into the reform. The costs of care are likely to rise sharply in the coming decades because the baby boomer cohorts are reaching old age. In today’s system, this is primarily at the expense of the public sector. The health insurance contributions per nursing patient are capped, the cantons and municipalities pay the rest. If care now becomes part of the reform package, the insurers and thus the premium payers will have to contribute more to the cost increases.
The Council of States only wants to cap the health insurance contribution during a transitional phase. The fact that the cantons wanted to get rid of the obligation to finance the remainder did not bode well for the population, said Rechsteiner. This is a further affront to households with low and middle incomes, which chronically suffer from a premium burden that is far too high, writes the trade union federation.
For once, the SP and the health insurers that it often criticizes are on the same page. Insurers have also opposed the inclusion of nursing care. But because they know that without the yes of the cantons, the reform will fail, they offer a hand for a compromise.
Insurers assume that the reform will dampen premium growth despite the inclusion of long-term care. The Curafutura health insurance association, one of the drivers of the reform, is even more convinced of this than Santésuisse. This fears that the advantages would be nullified. Curafutura is based on a study by the consulting firm PwC. With a broad shift to the outpatient sector, it expects annual savings of around CHF 1 billion. On the other hand, there are additional costs due to maintenance. In a study by Infras commissioned by the cantons, these are estimated at CHF 600 million per year.
However, this calculation was made before the vote on the care initiative. Santésuisse assumes that the population’s approval of the initiative will lead to a further increase in the cost of care. The 600 million francs are therefore rather low.
Clear majority for uniform financing
In the end, the supporters were clearly in the majority in the Council of States. The small chamber voted 29 to 6 in favor of uniform financing (Efas). The no votes and 5 abstentions all came from representatives of the SP and Greens.
According to the decision of the Council of States, in future the cantons will have to pay at least 26.9 percent and the health insurers will have to pay a maximum of 73.1 percent of the services via the premiums – regardless of where and by whom they are provided. The cantons have seven years to convert. The bill now goes back to the National Council.