The most important facts about the standardized financing of healthcare services
Published: Sunday, Nov 24th 2024, 05:40
Updated At: Sunday, Nov 24th 2024, 04:41
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This Sunday, Switzerland votes on the uniform financing of outpatient and inpatient healthcare services. The VPOD trade union is fighting this paradigm shift in the healthcare system with a referendum. The most important facts about the bill:
The initial situation
Healthcare services covered by basic insurance are currently financed differently depending on where they are provided. The cantons pay 55 percent of inpatient services. The health insurance fund pays 45 percent. Outpatient treatment is paid for by the health insurance fund alone. In long-term care, patients and health insurance companies each pay a fixed contribution towards the cost of care. The remainder is covered by the cantons and/or the municipality of residence, depending on the canton. On average, the health insurance companies covered around 54% of care costs in 2022 and the cantons 46%.
Outpatient treatment cost around CHF 23 billion in 2022 and inpatient treatment around CHF 15 billion. Nursing services cost around 6 billion francs.
This is what the bill wants
The Efas proposal ("Uniform financing of outpatient and inpatient care") brings the financing of all healthcare services from a single source. The cantons are to cover at least 26.9% of the costs (after deduction of the patient's deductible and retention fee) and the health insurance funds are to cover a maximum of 73.1% via the premiums. The uniform financing of outpatient and inpatient treatment is to be implemented from 2028. In certain cases, according to the Federal Council, patients may have to pay a higher share of the costs for inpatient treatment compared to today.
In long-term care, the system change will take place in 2032. One prerequisite for the changeover in long-term care is uniform and cost-covering tariffs, which must first be negotiated.
Because they co-finance all services, the cantons are given additional control options.
What the supporters say
Proponents expect the bill to remove false incentives, namely because there will be fewer hospital stays and later admissions to nursing homes. From the point of view of health insurance companies, hospital stays are currently attractive because the cantons only co-pay for inpatient treatment. In addition, the coordination of care is improving, which is particularly beneficial for the chronically ill. According to a study commissioned by the federal government, this could save up to 440 million francs a year. The fact that more treatments would be carried out on an outpatient basis would reduce premiums by around two billion francs in the year of introduction.
The cantons wanted long-term care to be included in the bill. According to the Conference of Cantonal Governments, this means that the health insurance funds are also bearing the cost development in nursing homes. However, this would not place a greater burden on premium payers, as the cantons would in turn contribute to cost growth in the outpatient sector and for medication.
The Federal Council and Parliament support the bill. The SVP, Center Party, GLP and EVP recommend a Yes vote. The Greens decided not to vote, as did the central board of the Professional Association of Nursing Women and Men (SBK).
What the opponents say
The VPOD trade union has launched a referendum against Efas; the Federation of Trade Unions, the Unia trade union and the SP are now campaigning for a No vote. In their words, the reform pushed through by the health insurance funds and the conservatives in parliament is harmful. The change of system would bring about a deterioration for nursing staff and patients because power would shift to the health insurance funds. It is not the health insurance funds, but the public sector that should control healthcare.
Opponents also fear higher premiums, particularly due to the inclusion of long-term care. Expenditure would rise particularly sharply in this area. They also fear that the cantons would relinquish responsibility for care. If the cantons were to withdraw from responsibility for financing and organizing nursing homes and Spitex, the "red carpet" would be rolled out to private, profit-oriented players.
How the template arrives
In the latest polls, the proposal was received rather positively. However, the race is likely to be decided by the relatively large number of undecided voters. In the SRG survey, 54% of respondents were in favor of the bill and 37% opposed it. In the survey for "20 Minuten"/Tamedia, 46% were in favor and 44% against.
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