Hospital planning

The Federal Constitution assigns responsibility for hospital planning to the cantons. As part of this task, the Federal Health Insurance Act (KVG) requires the cantons to determine which hospitals may charge their services to mandatory healthcare insurance by including them on approved hospital lists (i.e. awarding performance mandates); in doing so, they must take the planning criteria set out in the Health Insurance Ordinance (KVV, Articles 58a to 58e) into account. Planning must be geared to demand, and the cantons are called upon to coordinate their plans in this area with the clear goals of preventing any oversupply and containing costs and ensuring the necessary quality. Apart from a few instances of cooperation, all of which are confined to a small geographical area, the coordination of plans between the cantons is not yet taking place to the desired degree. Most cantons’ hospital plans reflect the situation within their own borders and are primarily driven by local and economic interests. This ‘competition’ between cantons means that new surplus capacities are being created in addition to those that already exist. Many locations are seeking to strengthen their appeal by strengthening the image of their hospitals (through public services, investments, etc.). Actions of this kind ultimately distort the market by putting other hospitals at a disadvantage. The current intercantonal race to invest shows the extent to which local, economic interests act as a driving force. Instead of curbing costs, this kind of hospital planning necessarily causes them to rise – as a rule, the existing surplus capacities are refinanced by way of overprovision. The cantons have clearly failed to use the considerable planning leeway they enjoy as a means of achieving overarching healthcare policy objectives. Their multiple role as hospital operator, supervisory and licensing body must surely be a factor. Therefore, it is crucial that existing conflicts of interest are resolved so that a system of hospital planning which is both meaningful and covers the actual needs of the population can be introduced at the regional level.

To this end, CSS Insurance also supports the demand (M14) put forward by the group of experts appointed by the Federal Council that, in future, regional hospital planning based on hospital lists covering larger regions should concentrate the supply of inpatient services and eliminate duplication between individual cantons. CSS also supports the idea of giving health insurance industry associations the right to appeal against cantonal inpatient planning, as provided for in the Federal Council’s first package of measures.

The Federal Council wishes to further standardise the planning criteria used by the cantons for hospitals, birth centres and care homes by amending the ordinance accordingly. The cantons would have to better coordinate the planning of hospitals and care homes. In addition, hospitals on cantonal lists would no longer pay out any volume-related compensation or bonuses. The aim here is to combat increased service volumes that are not medically justified. CSS welcomes stricter planning criteria. By specifying a system of remuneration based on groups of services and placing greater emphasis on hospital cost-effectiveness and quality in healthcare planning, the Federal Council is helping to bring about the necessary standardisation of cantonal hospital planning. Its intention to expand intercantonal cooperation will do much to step up the desired concentration of the services on offer. However, CSS decidedly opposes the setting of maximum service volumes as a steering instrument to be used by the cantons. On the one hand, the insurers would not be able to verify whether the specific cantonal quotas had been met. On the other hand, the situation must not be allowed to arise in which the cantons can evade their obligation to cover costs, thus shifting their share of the funding ostensibly to the patients, but de facto to the supplementary insurance sector. That is why CSS is calling on the cantons to remain liable for their share in accordance with Art. 49a KVG, even in cases where a hospital fails to satisfy the stated requirements. Instead, the cantons should be able to impose sanctions on any hospitals that breach the rules, for example by placing a time limit on their inclusion on the hospital list.