Questions and answers on the cost brake initiative
Published: Sunday, May 5th 2024, 09:42
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On June 9, the people and cantons will vote on the popular initiative "For lower premiums - cost brake in the healthcare system (cost brake initiative)" by the Center Party. Below are the most important questions and answers on the proposal:
HOW HAVE HEALTHCARE COSTS DEVELOPED?
Over the past ten years, the costs of compulsory health insurance have risen by around 31%, while wages have only increased by around 6% in the same period. According to surveys, healthcare costs have become the population's biggest concern - ahead of pension provision and the climate crisis. The reason for this is that health insurance premiums are rising in line with healthcare costs.
WHAT ARE THE CAUSES OF THE RISE IN COSTS?
There are several reasons for the rise in healthcare costs: Firstly, the number of older people is increasing and with it the number of chronically ill people who need more medical treatment. In addition, medical and technological advances can increase costs because there are more and better treatment options and these are also being used more. More and more services and medicines are also being reimbursed by basic insurance.
In addition, there is duplication, misguided incentives and inefficient structures in the healthcare system, which lead to many treatments being carried out that are not medically justifiable.
WHAT ARE POLITICIANS DOING TO COMBAT COST GROWTH?
Politicians have been trying to take countermeasures for years. Several reform packages aimed at curbing the rise in healthcare costs and premiums have either failed or been watered down by parliament. In 2019, an expert report commissioned by the federal government identified potential savings of CHF 6 to 8 billion - without compromising the quality of healthcare.
Everyone agrees that new recipes are needed to combat the constantly rising costs of healthcare. What these should be remains to be seen. For example, a consistent shift of inpatient treatment to the outpatient sector and a revision of the outdated Tarmed tariff structure are repeatedly mentioned. Inter-cantonal coordination must also be improved and the efficiency of care increased.
WAS WILL DIE INITIATIVE?
The petition for a referendum calls for the introduction of a cost brake in compulsory health insurance and aims to break the reform backlog. If the increase in average costs per insured person and year in compulsory healthcare insurance is more than a fifth higher than the increase in nominal wages two years after the initiative is adopted and the tariff partners - i.e. cantons, hospitals, doctors, health insurance companies and the pharmaceutical industry - have not taken any measures by this time, the federal government and cantons must decide on cost-reducing measures.
The measures must take effect in the following year. The extent to which costs may rise in the longer term must be determined by parliament in the law. The exact form of the cost brake and the measures with which the Confederation and cantons are to curb costs are not specified in the initiative text. However, the center party refers to the federal government's proven debt and expenditure brake.
WHO IS BEHIND THE INITIATIVE?
The centrist party submitted the cost brake initiative in 2020. In order to finally change things and stop the explosion in premiums, the credo was that pressure from a popular initiative was needed now. The centrist party claims that several proposals to cut costs in the healthcare system have long been known. The initiative is supported by the health insurance association Santésuisse and the small parties EVP and EDU.
WHAT DO THE SUPPORTERS SAY?
"With the cost brake, we are putting pressure on people to finally take action," say the initiators. All stakeholders must take responsibility for cost trends. False incentives and cost drivers in the healthcare system should be tackled structurally.
According to the centrist party, this includes, for example, medicines that are too expensive. These sometimes cost five times as much in Switzerland as abroad. According to the initiators, a further billion francs could be saved each year by increasing outpatient rather than inpatient treatment. The initiative could also lead to a simplification and reduction of unnecessary administrative costs.
WHO IS FIGHTING THE INITIATIVE?
The Federal Council, cantons and most players in the healthcare sector recognize the importance of cost containment in the healthcare sector, but reject the initiative. Among the major parties, representatives of the SVP, SP, FDP, GLP and the Greens are involved in the No Committee.
WHAT DO THE OPPONENTS SAY?
By linking the braking mechanism exclusively to economic and wage developments, the initiative falls short and is too rigid, argue the opponents. The proposal does not take into account factors such as the ageing population or advances in medical technology. No new constitutional article is needed to adopt cost-cutting measures.
Opponents are also warning of a reduction in services if the initiative is accepted. According to the No Committee, hospitals, care facilities and other healthcare providers would then have to cut back on urgently needed services. "It would lead to two-tier medicine." In addition, the working conditions of healthcare staff would deteriorate. The initiators dispute this. With total costs of almost 90 billion francs, there is potential for savings without reducing services.
WHAT DOES THE COUNTER-PROPOSAL CONTAIN?
Opponents would prefer the indirect counter-proposal adopted by Parliament, which would come into force if the initiative is rejected. This provides for the Federal Council, in consultation with healthcare stakeholders, to determine every four years how much the costs of compulsory health insurance may increase at most. The players in the healthcare system would have to justify in advance why and how much the costs per area will increase.
The cantons could also set their own cost and quality targets, taking into account the guidelines of the Federal Council and consulting insurers, insured persons and service providers in advance. A commission for cost and quality monitoring should monitor the development of costs and make recommendations to the federal government and the tariff partners on suitable cost containment measures.
HOW DOES THE INITIATIVE PERFORM IN SURVEYS?
Supporters of the initiative currently have an advantage. According to the survey conducted by "20 Minuten" and Tamedia, 54% would have voted Yes if the referendum had been held in mid-April. 38 percent of respondents would have voted no. In the first SRG trend poll, 52% of respondents voted Yes and 41% voted No.
According to the opinion research institute gfs.bern, however, the initiative is likely to be rejected if support wanes to the usual extent during the referendum campaign. There are currently differences between the language regions: Support for the initiative is higher in French-speaking Switzerland and Ticino than in German-speaking Switzerland.
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