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CSS Insurance

Uniform outpatient / inpatient financing (EFAS)

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. The redistribution of the cantonal funds would have to take place on a risk-adjusted basis to avoid further misplaced incentives and a decline in efficiency. 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 would clearly welcome 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 helping them to become more widespread.