Children’s hospitals seek help

Last weekend, seven-month-old Avi started coughing. Then came the fire. Breathing quickened, the baby was exhausted. Stéphanie Sutter (37) from Liestal BL took her son to the pediatrician. Diagnosis: Respiratory syncytial virus (RSV). Viral infection of the respiratory tract is causing problems for our little ones and has been common in Switzerland for weeks.

On Wednesday, an ambulance brought little Avi to the University Children’s Hospital in Basel. After 3 hours in the crowded emergency room, the mother and child were given a room. Since then, Avi receives round-the-clock medical care.

Insidious RS virus

“The nursing staff are doing an incredible job,” says Stéphanie Sutter. “They accompany and support not only Avi but also me.” Sutter says he was never afraid that Avi would fail. “But those were stressful days. It all happened so fast.”

That’s the danger of the RS virus, says Caroline Stade, 55, head of the nursing department at Basel Children’s Hospital. “Babies get seriously ill in a short time.” Stade has been in maintenance for 35 years but has never experienced such a burden. The RS virus and the growing number of flu infections are putting a lot of pressure on the children’s hospital. “Beds are full. Staff don’t come every day. Staff struggle with stress and fatigue.”

The children’s hospital has delayed most of its planned inpatient interventions. This freed up the operating room – and with it the staff who now take care of small RSV patients.

Most outpatient treatments

However, this does not mean that the state of emergency is over. Because inpatient treatments in children’s hospitals constitute a very small part of the total volume.

A large part of it is outpatient treatment, from the emergency room to bloodletting and consultation. This is linked to a problem that goes far beyond the current state of emergency: Children’s hospitals in this region are losing tons of money every day. “Every outpatient creates a shortage,” says Caroline Stade.

Responsible for this is the Tarmed doctor’s schedule. It determines how much outpatient services can cost. In 2014 and 2018, Health Minister Alain Berset (50) intervened in this tariff and ordered a reduction in order to save costs.

A quarter of the costs are not covered

However, what at best leads to cost reductions in adult medicine means huge losses for children’s hospitals: the treatment of children is much more complex than that of adults – but the current tariff system does not take this into account. Result: A quarter of costs are not covered. st. Gallen, Zurich, Basel, Bern, Lausanne VD and the six large children’s hospitals in Geneva together run a deficit of 60 million francs in the outpatient sector every year. Rising trend.

Foundations, donors and supporting cantons have to plug the holes. That’s why they’ve been pressing Bern since 2018. In 2020, Parliament passed a motion to fund children’s hospitals, urging Alain Berset to take action against the million-dollar hole. The health minister had until last September to implement the motion. But it didn’t do anything.

parliamentary minutes

At the end of November, St. Benedikt Würth (54) of the Central Council of States of St. Gallen submitted another proposal. Würth wants to know why nothing happened from the Bundesrat. Unlike other areas, children’s hospitals have optimized their structures in recent years. “Inter-cantonal cooperation works,” says Würth. “Children’s hospitals should not be the penalty for the cost explosion in the healthcare system.”

Basel government councilor Lukas Engelberger (47) is in line. “The Federal Council must react,” says Sunday Blick, Chair of the Health Directors Conference.

Now children’s hospitals are also putting pressure on them. “The tariff interventions in 2014 and 2018 are responsible for the desolate financial situation of children’s hospitals in the outpatient district,” says Manfred Manser (72), Head of Children’s Hospital Basel. But here lies an opportunity: “Federal Councilor Alain Berset implemented collective bargaining interventions by decree. It can also fix them again.”

New tariff system needed

Manser says the Minister of Health must now start implementing the motion to finance children’s hospitals and introduce the new Tardoc tariff system. “That would be a huge relief.” Tardoc would cut the children’s hospital deficits in half. But tariff partners disagree. “Health insurance companies hide behind the federal government and the price controller,” says Manfred Manser. “And the federal government hides behind its collective bargaining partners.”

Maybe things are still moving forward. In the fall, St. Allkids, the alliance of children’s hospitals in Gallen, Zurich and Basel, sent a letter to Alain Berset, and the Minister of Health replied: At the end of January, he received representatives of children’s hospitals in Bern for a meeting. interview. “We are pleased with this meeting and hope that the trend will change,” says Manfred Manser.

“Time is running out”

Bettina Kuster (60), Director of Nursing at the University Children’s Hospital in Zurich, does the same. There are currently only 50 nursing staff absent due to illness. In addition, there are 30 quotas. Added to this is the pressure of the schedule: “Our days are tightly programmed,” says Kuster. “But we are reaching our limits. We do everything possible on an outpatient basis.” It’s better for kids and parents. “But it also means more effort to care – we’re being punished financially for that.”

Upon request, Berset’s department refers to ongoing negotiations.

“Time is running out,” says Caroline Stade, head of nursing in Basel. We need that money.”