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CSS Insurance

Financing of care

Arrangements for financing care of the elderly and long-term care basically fall within the remit of the state and its social policy. The new system of care financing that came into effect on 1 January 2011 reflected the political will to achieve two major goals: firstly, to avoid placing an additional financial burden on mandatory healthcare insurance (OKP), which had previously taken on more and more of the rising costs of age-related care, and, secondly, to improve the difficult social situation of certain groups of people who are reliant on care. The core element of these new arrangements, and thus the main factor in attaining the stated goals is the capping of OKP and patient contributions to care, with responsibility for the remaining costs being transferred to the cantons. Additional social policy measures include: increasing the eligibility threshold for supplementary benefits to the old-age and survivors' insurance (EL), introducing an attendance allowance for people demonstrating a slight degree of disability (‘helplessness’) who wish to receive care at home, and obliging the cantons to ensure that admission to a care home does not result in the patient becoming dependent on social assistance. The evaluation report on these new arrangements, published in July 2018, shows that both objectives have generally been achieved. Spending on care under mandatory healthcare insurance has stabilised and the share of costs funded by premiums has not increased. This means that there is no need to amend the legislation at present or to make any fundamental changes to the financing model (e.g. by making nursing insurance compulsory). Nevertheless, action is still required, especially as the cantons are not yet fully living up to their responsibility for residual financing. As a result, service providers are left with uncovered costs for nursing care. In the past, this has led to nursing homes disguising these costs as non-medical costs and charging them to the insured persons without justification.

The situation has been made worse for service providers, especially those providing outpatient services, since the Federal Administrative Court handed down two decisions in 2017 (C-3322/2015 and C-1970/2015) in which it condemned the practice of agreeing payments for nursing supplies in service agreements with health insurers as unlawful. The current, heated public debate on long-term care financing, especially with regard to aids and appliances and medical supplies, completely ignores the fact that payment in this area would be ensured without any actual funding gap arising if the cantons would simply comply with their legal obligation (Federal Supreme Court decision (9C_446/2017) to cover the remaining costs. And the current outrage of the cantons and communes at the increased burden of costs they are being asked to shoulder is barely comprehensible, given that the core element of the new care financing arrangements, i.e. the capping of the amount to be financed by premiums and patients’ co-payments respectively, must automatically lead to an increase in the share of these costs funded through tax revenues, as was always the intention. However, the cantons have obviously neglected to take these circumstances – especially in relation to demographic trends – into account in their budgets. Those hardest hit are nursing professionals involved in outpatient care who are required to use expensive and/or particularly large amounts of medical supplies. Some of these individuals now find their livelihood seriously threatened. However, only the cantons can directly resolve the situation – by meeting their obligation to finance the remaining costs.