Financing of healthcare services is now being standardized
Published: Sunday, Nov 24th 2024, 20:10
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The "yes" vote at the weekend marks the start of the implementation of the historic change to the healthcare financing system. However, only in a few years' time will all treatments paid for by basic insurance be financed with the same distribution from health insurers and cantons.
WHAT COMES AFTER THE YES?
The Efas proposal ("Uniform financing for outpatient and inpatient care") introduces uniform financing rules: The cantons are to pay at least 26.9% for all treatments and care services (after deduction of the patient's deductible and co-payment) and the health insurance funds are to pay a maximum of 73.1% via the premiums. The uniform financing of outpatient and inpatient treatment supported by the cantons is to be implemented from 2028.
WHY LATER IN LONG-TERM CARE?
Long-term care, on the other hand - homes and Spitex services - will be given until 2032 to implement the new requirements. This is because before the new model is introduced, uniform tariffs must be negotiated for care services, and these must cover the costs. The motion to fully implement the care initiative before standardized financing in care was not passed in parliament.
HOW IS WHAT FINANCED TODAY?
Healthcare services covered by basic insurance are currently financed differently. The cantons pay 55% of inpatient services - if the patient stays overnight in hospital - from tax revenue. The health insurance company pays 45 percent. Outpatient treatment - when patients go home on the same day as the procedure - is paid for by the health insurance fund alone. In long-term care - for example in a nursing home - the patients and the health insurance companies each pay a fixed contribution to the care costs. Depending on the canton, the rest is covered by the cantons and/or the municipality of residence. On average, health insurance companies covered around 54% of care costs in 2022 and the cantons 46%.
ARE COSTS SHIFTING?
The new cost sharing is based on the average of the reference years 2016 to 2019. In relation to these four years, the switch to the Efas model is cost-neutral for the health insurance funds and the cantons on balance. As the trend towards more outpatient treatments has continued since then and is likely to continue, proponents expect the balance to shift in favor of premium payers. There is talk of around two billion francs at the time of introduction. The coordination of treatments - which is particularly important for patients with chronic and multiple illnesses - is currently mainly at the expense of the health insurers. Here, too, the new guidelines should have a positive impact on premiums.
WHAT WILL CHANGE FOR PATIENTS?
Not much from the outside. However, patients should be able to benefit from the trend towards more outpatient treatment. Switzerland currently has fewer outpatient treatments than comparable other countries. If several service providers are involved in a treatment, the agreements should be improved thanks to financial incentives. In certain cases, according to the Federal Council, patients may have to pay more for inpatient treatment than they do today.
WHERE IS THE DEVELOPMENT HEADING?
Thanks to medical advances, more and more surgical procedures can be performed without hospitalization. This reduces costs on balance, but is not attractive from the point of view of health insurers and is reflected in premiums under the current financing rules. More and more elderly people in Switzerland are dependent on care and assistance in their everyday lives. Not only are healthcare costs rising year on year, but so are health insurance premiums.
WHO SUPPORTED THE BILL?
The Federal Council and Parliament supported the bill initiated in 2009 by the then Aargau CVP National Councillor Ruth Humbel (AG). The cantons also supported it. The majority of all parliamentary groups voted in favor. The SVP, Center, GLP and EVP recommended a yes vote. The Greens decided to abstain from voting, as did the central board of the Professional Association of Nursing Women and Men and the employees' umbrella organization Travail Suisse.
HOW DID THE SUPPORTERS REACT?
Supporters interpret the Yes vote as proof that reforms in the healthcare system are possible. Existing false incentives would now be eliminated. The hospital association H+ wrote that this reform was crucial for hospitals in order to drive forward the politically demanded and medically sensible shift to the outpatient sector. The health insurance association Curafutura - with the insurers CSS, Helsana and Sanitas - spoke of a "historic yes" for patients, but also for the healthcare system and premium payers. The Conference of Cantonal Health Directors warned against a miracle pill, but expects benefits for patients and premium payers.
WHO WERE THE OPPONENTS?
The VPOD trade union launched a referendum against the bill; the Federation of Trade Unions, the Unia trade union and the SP also campaigned for a no vote. In parliament, the SP, Green and SVP parliamentary groups voted against the bill.
HOW DID THE OPPONENTS REACT?
Opponents warned that premiums could rise due to the inclusion of long-term care. The trade union federation fears higher premiums and more pressure on care quality and staff. The consequences of the Efas implementation are not foreseeable, warned the trade union Unia. The Greens called for a further change in the system, namely from per capita premiums for basic insurance to premiums based on income and assets.
HOW DID THE VOTE END?
Around 1,302,500 voters cast a Yes vote on Sunday and 1,140,800 voted No. This represents a Yes share of 53.3 percent. The French-speaking parts of the country predominantly said no to the bill, but were outvoted by the German-speaking population. The voter turnout was just under 45 percent. The supporters had budgeted more funds for the campaign than the opponents.
WILL THERE BE FURTHER REFORMS?
Health Minister Elisabeth Baume-Schneider spoke of an important reform step. However, further reforms must follow. One of these is the care initiative adopted in 2021. Its implementation should improve working conditions in the care sector. Cost-cutting measures in the healthcare system are already being discussed in parliament. And around two weeks ago, the stakeholders agreed on joint savings targets at a round table.
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