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CSS Insurance

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. 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. That is why CSS Insurance is calling for the wording of the KVG to be amended in such a way that it would oblige the cantons – as is already the case with regard to highly specialised medicine – to coordinate their hospital planning and draw up joint hospital lists on the basis of a sensible number of catchment regions. Should the cantons fail to complete this task within a reasonable period of time, their powers would then pass to the Federal Council, which would assume responsibility for implementation.

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.