Per capita healthcare costs continue to rise at rates that by far outstrip the cost of living and wage growth. Health insurer's premiums rise at the same rate, as premiums must always cover costs. CSS agrees with the initiative in the sense that this tendency is causing many households – especially middle-income families – to experience financial difficulties. For CSS, a worrying situation.
The popular initiative aims to cap this premium burden at 10% of the household's available income and harmonise the system of individual premium reductions (IPR). However, CSS believes this initiative is merely an expensive way of tackling symptoms. The initiative does nothing to address the root causes of cost growth. First, it is to be feared that much-needed efforts to improve efficiency and quality will be slowed down if rising costs are concealed by a massive expansion of the IPR system. Second, individual premium reductions would have to double within the space of 20 years in order to achieve the same level of cushioning as they do today. In other words, the initiative is not sustainable in the long term. In addition, unlike in the indirect counter-proposal, the main financial burden would have to be borne by the federal government and not the cantons, although it is the latter who actually play a key role in avoiding inefficiency and oversupply. Furthermore, the initiative weakens alternative insurance models: were the initiative to be adopted, insured persons would have to spend at most 10% of their income on premiums, leaving them with fewer incentives to take out cheaper forms of insurance – depending on how the initiative was implemented.
That is why CSS supports the indirect counter-proposal, which is currently being discussed and according to which the cantonal contribution to the premium reductions would be linked to the gross cost of healthcare in the respective canton. The counter-proposal would mean that cantons with higher healthcare costs and a higher household premium burden would have to pay more overall than cantons with lower costs. The counterproposal also creates incentives for taking action to contain healthcare costs (hospital planning, admission, etc.): cantons would be in charge of hospital planning, approving or setting tariffs, and would continue to control the recognition of outpatient service providers. Therefore, they would also be expected to exercise responsibility for premium reductions.
However, reforms in the health sector, which have an impact not only on the financing side but also on the cost side, remain necessary. Even though CSS believes the indirect counter-proposal to be a step in the right direction, it is especially important to also curb healthcare costs and thus relieve the burden placed on the insured persons. This is the aim of the current reforms.