Uniform outpatient / inpatient financing (EFAS)

Although outpatient treatment is mostly cheaper than inpatient procedures, many cases are nevertheless treated on an inpatient basis. One of the reasons can be found in the way the system is financed. Outpatient treatment is funded entirely through the premiums paid by insured persons, while no more than 45% of the cost of inpatient treatment is covered by their health insurer. As a result, some procedures are performed on an inpatient basis although the same level of medical care could be provided on an outpatient basis for less money. This holds back both the sensible shift towards outpatient care and the development of integrated care. These false incentives could be eliminated by adopting a uniform system of financing for outpatient and inpatient services (EFAS) which proposes that, in future, health insurers will reimburse 100 per cent of the costs in all service areas while the cantons fund a share of the total costs in their canton equivalent to the contribution they are currently making towards inpatient care. These funds would find their way back into the system, thus preventing a rise in premiums for insured persons. EFAS is supported by all the market participants and relevant professional associations. Only a few cantons have voiced opposition to the reform thus far. CSS itself expressly welcomes a rapid changeover to uniform financing, as the latter not only eliminates the false incentives in the system, it also allows additional discounts to be offered for integrated care models, thus, benefiting the insured persons. Moreover, EFAS would mean that the checking of bills for services provided would no longer be duplicated, but be carried out solely by the insurer as a 'one-stop shop'.

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