Questions and answers on uniform financing in the healthcare system
Published: Monday, Oct 28th 2024, 10:40
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On November 24, the electorate will vote on the uniform financing of outpatient and inpatient healthcare services. The VPOD trade union has launched a referendum against this paradigm shift. Here are the most important facts about the bill:
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%.
Outpatient treatment cost around CHF 23 billion in 2022 and inpatient treatment around CHF 15 billion. Nursing services cost around 6 billion francs.
WHERE IS THE DEVELOPMENT HEADING?
Thanks to medical advances, more and more surgical procedures can be performed on an outpatient basis. This reduces costs on balance, but is not attractive from the point of view of health insurance companies and is reflected in premiums under the current financing rules. More and more older people in Switzerland are dependent on care and assistance in their everyday lives. Increasingly, old and sick people wish to live in their own homes until they die and to be cared for there if necessary. Not only are healthcare costs rising from year to year, but also health insurance premiums.
WHAT DOES THE TEMPLATE CHANGE?
The Efas proposal ("Uniform financing of 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 deductibles and patient co-payments) and the health insurance funds are to pay a maximum of 73.1% via the premiums. The uniform financing of outpatient and inpatient treatment is to be implemented from 2028, and for long-term care from 2032. Its integration into the bill was controversial in parliament.
WHY LATER IN LONG-TERM CARE?
The care sector - homes and Spitex services - will be given more time to implement Efas. Before the new model is introduced, uniform tariffs must be negotiated for care services, and these care tariffs must cover the costs. The proposal to fully implement the care initiative before the standardized financing of care comes into force did not pass in Parliament.
ARE COSTS SHIFTING?
The cost sharing in the proposal relates to the average of the reference years 2016 to 2019. Based on these four years, the switch to the Efas model is cost-neutral for the health insurance funds and the cantons. Because the trend towards more outpatient treatment has continued since then and is likely to continue, proponents expect the introduction of Efas to shift the balance in favor of premium payers. There is talk of around two billion Swiss francs from the introduction of uniform financing.
WAS WOLLEN DIE KANTONE?
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 care homes. However, this does not place a greater burden on those paying premiums, as the cantons, for their part, would share the cost growth in the outpatient sector and for medication with their contributions.
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 the treatment of a sick person, financial incentives should improve the arrangements. According to proponents, this will also ultimately benefit patients.
WHO SUPPORTS THE PROPOSAL?
The Federal Council and Parliament support the bill initiated in 2009 by Ruth Humbel (AG), then a member of the CVP National Council from Aargau. The cantons support it. The majority of all parliamentary groups voted in favor. The SVP, Center Party, GLP and EVP recommended a yes vote. The Greens decided not to vote, as did the central board of the Professional Association of Nurses (SBK) and the employees' umbrella organization Travail Suisse.
WHAT DO THE SUPPORTERS SAY?
The proponents of Efas expect more outpatient and less inpatient treatment. This should reduce the burden on premium payers and avoid hospital stays and premature admissions to nursing homes. After all, care at home currently costs the insurance companies more than care in a home. Coordination should also improve. Under the current law, the costs for this are mainly incurred in the outpatient sector, at the expense of the health insurance funds and premium payers. The effects of better coordination, on the other hand, are often reflected in fewer hospital admissions - which reduces the burden on the cantons. The proponents expect an improvement because all parties involved would now be interested in agreements in order to avoid multiple clarifications and save costs. According to a study commissioned by the federal government, more outpatient treatment and better coordination could save around CHF 440 million per year.
WHO ARE THE OPPONENTS?
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 parliament, the SP, Green and SVP parliamentary groups voted against the bill. The Greens decided to abstain from voting, as did the central board of the Professional Association of Nurses (SBK) and the employees' umbrella organization Travail Suisse.
WHAT DO THE OPPONENTS SAY?
The opponents focus on the distribution of costs. The bill shifts costs between health insurance funds and cantons, but contains no real control mechanisms. The reform pushed through by the health insurance funds and the conservatives in parliament is harmful. It would mean worse conditions for nursing staff and also for patients, because power would be shifted to the health insurance funds. It is not the health insurance funds, but the public sector that should control healthcare.
Opponents fear that premiums will continue to rise, particularly due to the inclusion of long-term care, because of the ageing population and the increasing demand for care services. In the longer term, patients in long-term care would also have to pay more than they do today. If the cantons were to withdraw from the financing and organizational responsibility for nursing homes and Spitex, the "red carpet" would be rolled out for private, profit-oriented players.
HOW HIGH ARE THE CAMPAIGN BUDGETS?
The "Healthcare with a future" alliance, to which the Swiss Medical Association FMH, Curafutura, the hospital association H+, Spitex Switzerland and Interpharma, among others, have pledged substantial contributions, has declared a budget of over CHF 1.5 million for the Yes campaign, as evaluations by the Swiss Federal Audit Office (SFAO) show. The opponents - trade unions and the SP - have so far declared budgets totaling just over CHF 500,000. The Swiss Federation of Trade Unions spends by far the most money.
HOW IS THE PROPOSAL RECEIVED?
According to the surveys, there are still many undecided voters. In the poll commissioned by SRG, 61% of respondents were in favor of unified financing and 26% were against it. 13 percent gave no answer. In the Tamedia/"20 Minuten" survey, supporters and opponents of the proposal were evenly balanced at 38% each. Almost a quarter did not answer the voting question.
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