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CSS Insurance

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. This means that, where there is no medical difference between inpatient and outpatient treatment, the system works in such a way that those financing the treatment have little incentive to ask for the cheaper outpatient option. In order to change this, the curafutura association of health insurers has come up with a concept for placing the financing of outpatient and inpatient costs on an equal footing which proposes that, in future, health insurers will pay 100 percent 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 on a risk-adjusted basis via the risk-compensation mechanism, thus preventing a rise in premiums for insured persons. This proposal is supported by all the market participants and relevant professional associations. It is only the cantons that are reluctant to embrace this change. CSS itself would clearly welcome a rapid changeover to the uniform financing of outpatient and inpatient services (EFAS), as the latter eliminates the false incentives in the system instead of merely shifting them elsewhere.