Councils fundamentally restructure the financing of the healthcare system
Published: Monday, Dec 18th 2023, 16:40
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Parliament is fundamentally restructuring the financing of the healthcare system. The monism bill, which provides for all services to be financed from the same pot, is ready for the final vote.
On Monday, the Council of States tacitly resolved the last difference in the bill. This means that the goal of amending the bill in the current session has been achieved after 14 years of deliberation.
The "Uniform Financing of Outpatient and Inpatient Care" (Efas) is intended to help curb healthcare costs and eliminate disincentives for treatment.
Integration mandatory for cantons
The last point of contention was the conditions under which long-term care should be integrated into the uniform cost-sharing system - this integration is mandatory for the cantons. The Council of States had only wanted to set a deadline of seven years from the creation of the bill as a criterion.
The National Council insisted on a further condition and ultimately prevailed: There must be tariffs for care services that are based on a uniform, transparent cost and data basis. And the tariffs must cover the costs.
However, the National Council dropped its second condition. It had initially wanted the popular initiative "For strong long-term care (care initiative)" to be fully implemented before long-term care was integrated into the monism. However, the Council of States did not want to know anything about this; the National Council agreed.
The cantons should now pay at least 26.9% and health insurers at most 73.1% of service costs through premiums. Insured persons must continue to pay a specific contribution for long-term care services, whether outpatient or inpatient. The cantons can assume the contribution.
The Councils did not agree for a long time on retaining the capped care contribution - currently CHF 23 per day. The Council of States felt that the abolition would primarily relieve the burden on the wealthy and place an additional burden on the cantons. The National Council wanted to abolish the contribution and finally gave in. A red-green minority in the upper chamber defended the deletion to the end, but lost.
The share of compulsory health insurance (OKP) in the financing of contract hospitals - hospitals that are not on cantonal hospital lists - remains at the current 45%. This should prevent an increase in premiums and put these hospitals in a better position than those on the list.
Referendum in play
The complex monism bill was initiated by former Aargau healthcare politician and National Councillor Ruth Humbel (center) in 2009. It was not until 2019 that the bill drafted by the responsible National Council committee came before parliament. The proponents expect it to deliver considerable savings potential.
The bill brings about a fundamental reform in the financing of healthcare services, namely their financing from a single source. Today, outpatient treatment is paid for by the health insurance companies alone, from premium money. At least 55 percent of inpatient services are covered by the cantons. The rest is paid by the health insurance funds.
Over the past few days, nursing staff associations have called for a referendum. The bill is wrong and dangerous - for nursing staff, the quality of care and for the insured, wrote the VPOD, for example.
Council of States wants review mandate
Immediately after its decision, the Council of States decided on a review mandate: the Federal Council must evaluate whether the restructuring of the financing of healthcare services is cost-neutral for cantons and health insurance companies - in relation to the years 2016 to 2019. It should also investigate whether health insurance premiums are correspondingly lower in cantons where the financial contribution increases.
If necessary, the law would have to be amended. The Federal Council agreed to the motion, which the National Council also supports in principle. As the Grand Chamber had made an amendment to the text, it now has to decide once again.
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