The current hospital financing system came into force in 2012, establishing a flat-rate payment system for all the care and services given to a patient during hospitalisation. When awarding the performance mandates for inpatient services, the cantons must give equal consideration to both private and public providers. Patients are able to select a hospital anywhere in Switzerland from the approved list. This is intended to kick start or boost competition amongst hospitals. In the long term, those service providers that deliver their services efficiently and maintain an adequate quality should be able to establish themselves on the market. To achieve this, a change from the previous cost-reimbursement principle to the current performance-based payment was necessary. In other words, the costs of an individual hospital must no longer be allowed to determine the tariff. Instead, it should be based on a price achieved by efficient hospitals.
The question of what role the cantons should play in hospital planning still remains to be discussed, as does the call for uniform funding rules for outpatient and inpatient services. Alongside their role as supervisory authorities and planners of healthcare provision, the cantons also own and finance hospitals. By investing public funds in their own hospitals, setting global budgets or capping service volumes for certain hospitals, many cantons help preserve a structure of inefficient hospitals that contradicts the principle of competition and thus leads to the systematic discrimination of privately funded hospitals. The reference tariffs for treatment outside the canton of residence are often set too low, which both hinders competition and restricts insured persons in their freedom of choice. In this way, these cantons deliberately thwart the political aims of the new hospital financing system.
CSS Insurance additionally supports the idea called for by the group of experts appointed by the Federal Council to recommend measures for reining in the rising costs under mandatory healthcare insurance that, in future, hospitals which apply volume-related bonus agreements or kickbacks be excluded from the cantonal hospital planning lists in accordance with Article 39 paragraph 1 KVG. A ban on compensation systems for hospital staff (both internal and external) that ultimately serve to boost volumes or lead to unnecessary treatments (e.g. volume-related bonuses or kickbacks) could be included as a requirement in the performance mandate.