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H+ Hospital Association wants to go to court in the dispute over laboratory prices. The subject of discussion is the reduction in tariffs for laboratory analyzes ordered by the Federal Council in the summer of 2022.
It was a rare success for Health Minister Alain Berset (51), who cut his teeth trying to slow down cost growth in the healthcare system during his time in office: health insurance companies, and therefore premium payers, saved around 140 million francs annually.
But hospitals think the cut is arbitrary and illegal and want to reverse it a year and a half after it was implemented.
Flashback: In the spring of 2022, price observer Stefan Meierhans (55) harshly criticized the high laboratory tariffs in Switzerland. Compared to other countries, it appears that one billion francs could be saved for the benefit of premium payers. Tariffs were last adjusted in 2009 and are out of date due to automation. The Federal Office for Public Health (BAG) has been working on the recalculation of prices since 2020. Results won’t be released until 2025 at the earliest; It is too late for price watchdogs, health insurers and parliament: the Federal Council met their demand for a fast-track solution with a linear tariff reduction of ten percent.
Meierhans described this as “at best a homeopathically dosed tariff reduction”. Private laboratories and hospitals protested loudly. They criticized the price watchdog’s overseas comparison as misleading and the price reduction through the transition tariff as a political measure. However, there is no legal remedy against the Federal Council regulation. In order for the tariff reduction to be reviewed in court, service providers must therefore submit a special bill to the court against the health insurance company.
The Swiss Association of Medical Laboratories (FAMH) states that it has examined and rejected this possibility in order not to further disrupt the ongoing tariff calculation process at BAG.
More and more hospitals are in the red
However, H+ decided to attack. Kristian Schneider (52), director of the Biel Hospital Center and vice president of the Swiss Hospital Association, is on duty. H+ funds the model process that Biel Hospital must carry out. Schneider says this is not primarily about the laboratory tariff, but rather the way tariffs are “determined by the Federal Council without objective debate.” H+ accuses the state government of not treating providers equally with the linear reduction: since August 2022, this has only been applied to private laboratories and hospitals, not to general practitioners’ practices. “Hospitals are particularly disadvantaged; this selective price setting is an innovation we cannot allow,” says Schneider.
It is no coincidence that H+ wants to make a statement right now. Politicians will determine an important course in the debate on the financing of the Swiss healthcare system in 2024.
The challenges faced by Elisabeth Baume-Schneider (60) are great. As Berset’s successor at the head of the Ministry of Health, the Jura resident must advance the electronic patient record, roll out the care initiative, introduce a new doctor tariff, address the drug shortage and make inpatient hospital operations more cost-effective. comparisons. A giant project awaits you with the implementation of a single financing application for inpatient and outpatient treatment services.
In times of rapidly rising premiums, health insurers have clear ideas on how to avoid a cost explosion: In addition to low laboratory tariffs, the Santésuisse health insurance association calls for savings on medicines and clear efficiency criteria for hospital tariffs.
Providers complain that tariffs no longer cover costs, more hospitals are at risk, and warnings of healthcare system collapse are growing louder. H+ director Anne-Geneviève Bütikofer (51) recently said that tariffs are 30 percent too low, especially in the outpatient sector. Controversial lab prices have been the exception so far: Hospitals still make good money on them.
Hospital director Schneider does not deny this. But profits are urgently needed to finance other areas. In Biel BE, since the fall in laboratory prices, there has been a loss of 200,000 francs per year, transferred to the previously underfunded children’s clinic or speech therapy: “With the fall in laboratory prices, underfunding will worsen in general and spread into a previously profitable area.” Schneider demands that BAG be discussed with price changes rather than cuts.
Health insurance companies could face refunds running into millions
It now needs to start the sampling process to combat falling lab prices. To do this, hospital invoices for laboratory analyzes are issued according to old tariffs in order for the health insurance company to refuse the calculation, which can later be legally challenged.
Schneider failed on his first try: Analyzes billed digitally by Bernese health insurer Visana using outdated approaches were paid for without complaints, the hospital director said.
Visana denied this when asked: “To date, we have had no reason to reject invoices from Biel Hospital Center.” According to Schneider, excessive bills are now being resubmitted; this time via registered mail.
If hospitals win the Federal Council’s legal dispute over tariff reductions, health insurance companies could face refund claims of several hundred million francs.
The last time hospitals took legal action against Federal Council regulation was in 2014, when the Federal Council intervened in a dispute over the Tarmed doctor tariff. A clinic in Lucerne filed a test case against a health insurance company in an attempt to reverse the price adjustment, but was unsuccessful.
Source : Blick
I am Dawid Malan, a news reporter for 24 Instant News. I specialize in celebrity and entertainment news, writing stories that capture the attention of readers from all walks of life. My work has been featured in some of the world’s leading publications and I am passionate about delivering quality content to my readers.
