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CSS Insurance

Hospital financing / Uniform outpatient and inpatient financing (EFAS)

The current hospital financing system came into force in 2012, establishing a flat-rate payment system for all the care and services given to a patient during hospitalisation. When awarding the performance mandates for inpatient services, the cantons must give equal consideration to both private and public providers. Patients are able to select a hospital anywhere in Switzerland from the approved list. This is intended to kick start or boost competition amongst hospitals. In the long term, those service providers that deliver their services efficiently and maintain an adequate quality should be able to establish themselves on the market. To achieve this, a change from the previous cost-reimbursement principle to the current performance-based payment was necessary. In other words, the costs of an individual hospital must no longer be allowed to determine the tariff. Instead, it should be based on a price achieved by efficient hospitals.

The question of what role the cantons should play in hospital planning remains to be discussed, as does the call for uniform funding rules for outpatient and inpatient services. Alongside their role as supervisory authorities and planners of healthcare provision, the cantons also own and finance hospitals. By investing public funds in their own hospitals, many cantons help preserve a structure that contradicts the principle of competition and thus leads to the systematic discrimination of privately funded hospitals. In doing so, these cantons thwart the political aims of the new hospital financing system. CSS therefore welcomes the 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. In partnership with the curafutura association, CSS has developed a model for the implementation of EFAS, 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 what they are currently paying towards inpatient care. These funds would find their way back into the system via the risk-compensation mechanism, thus preventing a rise in premiums for insured persons.