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CSS Insurance

Financing of care

The present care financing arrangement has been in force since 1 January 2011. It stipulates the division of care-related costs between the mandatory healthcare insurance (OKP), the insured persons and the cantons. The Federal Act on the New System for Funding Care Services thus not only affects the OKP, but also the AHV, supplementary benefits and social assistance. The basic objectives of the new system of care financing are to avoid an additional financial burden being placed on the mandatory healthcare insurance and to restrict the financial risks of persons in need of care. Accordingly, limits have been placed on the maximum amount payable for care services by health insurers and by those receiving care services in nursing homes. The remaining amount will be met by the cantons or local authorities. Despite these new arrangements, there is still a need for action in the care sector. For example, different instruments (Besa, RAI, Plaisir) are still used in various regions throughout Switzerland to assess and classify the need for care. Therefore, depending on the instrument used, the same need for care can result in different minute values, with corresponding consequences for the division of financing. Since the cantons have thus far been given wide-ranging powers in implementing the new care financing system, which is therefore geared towards cantonal peculiarities, there is barely any coordination taking place between cantons. Consequently, the maximum co-payment of 20% of the costs of care by persons in need of such care are often exceeded, in particular if those persons receive care in a nursing home outside their own canton. The harmonisation project that was being jointly run by CURAVIVA, the cantons, the FOPH and insurers with the aim of calibrating the different instruments in such a way that the care requirement in any given case could generally be determined within minutes and with the same amount of effort under each system ultimately failed when the cantons pulled out of the project. The Confederation has not yet made use of its powers to enforce a uniform system in this respect. The Federal Office of Public Health (FOPH) has carried out an evaluation of the new system of care financing, examining whether the quality and cost-effectiveness of care provision was being warranted during the change of system and whether the social policy and competition policy goals had been achieved. The evaluation report is expected to be published in spring 2018. While this evaluation was still ongoing, some cantonal councils began issuing decrees in the middle of 2016 ordering adjustments to the system of care assessment tools. The majority of these system adjustments result in care home residents being assigned to a higher care category, which in turn puts a greater burden on mandatory healthcare insurance. CSS does not accept either these one-sided adjustments to the system or the implementation by the cantons.
 
CSS generally supports procedural requests to improve the current financing system. In view of demographic trends, CSS welcomes the efforts being made by politicians to come up with solutions for the sustainable funding of the care system.