Unresolved issues regarding the standardized financing of healthcare services
Published: Wednesday, Dec 6th 2023, 10:30
Updated At: Wednesday, Dec 6th 2023, 10:31
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Parliament has already decided that outpatient and inpatient healthcare services should be financed uniformly in future. However, there are still a number of unresolved issues regarding long-term care, even after the recent debate in the Council of States.
The Council of States' Social Security and Health Committee (SGK-S) had proposed to the Council by a clear majority that the previous decisions on the revision of the financing of healthcare services be retained. The Council of States followed suit on Wednesday. The bill will therefore return to the National Council. It is to be amended during the current session.
Controversial details
In principle, the councils agree that long-term care should be integrated into the so-called monism. However, many details are controversial: The Council of States wants to set a fixed deadline of seven years from January 1 after the revision comes into effect for the integration of long-term care. The National Council, on the other hand, wants to see additional conditions fulfilled, which the Council of States rejects.
In the opinion of the National Council, integration should only take place once the tariffs in the care sector have been established on a uniform and transparent cost basis. It also wants the popular initiative "For strong care (care initiative)" to be fully implemented before integration takes place.
The Council of States has now clearly rejected this proposal. Its responsible committee had found that setting a precise deadline for the inclusion of care would ensure greater legal certainty. The criterion of full implementation of the care initiative could not be precisely defined.
Peter Hegglin (center/ZG) wanted to build a bridge for the National Council. As an additional prerequisite for the system change, he proposed that tariffs should be available for care services that are based on a uniform, transparent cost and data basis. However, the Council rejected Hegglin's proposal by 31 votes to 12.
Controversial care contribution
Also unlike the National Council, the Council of States wants to retain the patient contribution to care services - in order to avoid considerable additional costs at the expense of the cantons. People in need of care currently pay CHF 23 per day for these services. The abolition of the contribution would primarily benefit insured persons in good financial circumstances, said Commission President Erich Ettlin (center/OW).
In order to prevent an increase in premiums, the Council of States wants to keep the share of compulsory health insurance (OKP) in the financing of contract hospitals - hospitals that are not on cantonal hospital lists - at the current 45%. The National Council wants to allow a higher contribution.
Fundamental reform
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, out of premium money. Inpatient services, on the other hand, are at least 55 percent financed by the cantons. The rest is paid by the health insurance funds. And specific rules apply to long-term care.
The aim of the complex monism proposal is to regulate the financing of healthcare services in a uniform manner. Health insurers and cantons are to jointly pay for outpatient and inpatient treatment covered by basic insurance. The bottom line is that the "uniform financing of outpatient and inpatient care" (Efas) should be cost-neutral.
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