Uniform financing
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, inpatient care only up to 45%. 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 can be eliminated by means of a uniform system of financing for services. The reform proposes that, in future, health insurers should pay 100% of the costs in all service areas while the cantons should fund a share of the total costs in their canton (currently at least 26.9% of the total costs), 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.
After 14 years of discussions in Parliament, the bill was adopted in the winter session of 2023. The following points in particular remained disputed right to the end:
- Inclusion of care: The uniform system of financing is also to apply to care, with a transitional period of seven years. That is the deadline by which the contracting parties must ensure that tariffs for care services are determined on the basis of uniform and transparent costs and data. However, Parliament did not insist that the ‘Care Initiative’ be fully implemented by then.
- Data access and invoice checking: Despite the change in the system, the cantons will continue to enjoy access to original inpatient invoices. In addition, they have been granted a right of objection. This means that the cantons can challenge an insurer’s assumption of costs if the service provider does not meet the licensing requirements, an unacceptable tariff has been applied or a tariff has not been applied correctly.
On 18 April 2024, the trade unions successfully called for a referendum. The popular vote will be held on 24 November 2024. If accepted, the bill will come into force for acute services on 1 January 2028 and for care services on 1 January 2032.
CSS is championing the bill via curafutura and the ‘pro’ alliance. It welcomes the adoption of this important reform, which boosts the shift towards outpatient care and gives fresh impetus to integrated care. In implementing the reform, it will be important to ensure that the controls involved in double-checking invoices for inpatient care (by health insurers and the cantons) are kept as lean and unbureaucratic as possible. As several members of parliament have pointed out, the cantons should merely check that the formalities have been correctly observed rather than conduct a full effectiveness, appropriateness and cost-effectiveness review. The contracting parties have been called upon to create conditions by 2032 that will enable EFAS (cost transparency) to be implemented in relation to nursing care.
Your health partner
As a health partner, we are committed to leading a healthy life, actively taking steps to regain one's health and developing a mindful approach to illness.
