Health insurance premiums: The cantons are part of the problem

Since 1996, everyone living in Switzerland must be insured with a health insurer. This obligation was introduced with the Healthcare Insurance Act (KVG), which was approved by voters two years earlier. Since then, the premiums have risen sharply, but the obligation has never been seriously questioned.

Now the Zurich health director Natalie Rickli (SVP) dares to “break a taboo”: In her opinion, “the abolition of compulsory health insurance should be considered”, she said in an interview with the “Sonntagszeitung”. And stuck in the wasp’s nest. The reactions were fierce and mostly negative.

Abolishing the obligation may have unforeseeable consequences. Rickli knows that. She herself emphasized that she “did not have a ready-made solution ready”. In fact, their idea is not well thought out. According to Rickli, basic insurance should continue for those in need. But what about the ‘bad risks’, i.e. older and chronically ill people?

Today they are “protected” by the mandatory obligation. If it drops, they’ll have a hard time finding affordable health insurance — if at all. Even the liberal NZZ points out that this aspect “driven” the politics of the 1996 reform. However, if the obligation is removed only for younger and healthy people, it can also be maintained.

Because even supposedly good risks can get into financial trouble in the event of a medical emergency without insurance. The US is a cautionary tale in this regard. Someone always pays in the end. It is possible that the costs of medical treatment will remain with the taxpayer and therefore also with the cantons.

In an interview, Natalie Rickli complained about a tendency to “burden the cantons with more and more costs”. This ball can be played back and the cantons are asked to do their “homework” first. Because in the complex Swiss healthcare system, which is difficult to reform, they are often part of the problem rather than part of the solution.

Another central element of the CoS reform is the individual premium reductions. With the uncontrolled increase in health care costs, its scope has also increased. More than a billion francs are available annually in the canton of Zurich alone, says Natalie Rickli. Nearly 30 percent of residents received a premium discount.

That’s only part of the truth. “While the federal government increases its contribution to reducing costs every year in line with costs, many cantons do not adjust their contributions accordingly,” the “Tages-Anzeiger” says on Tuesday. Ten cantons even paid out less money to policyholders last year than ten years earlier.

The figures are based on an evaluation by the Swiss Trade Union Confederation (SGB). Central secretary Reto Wyss said that the cantons are withholding money that the policyholders urgently need given the steadily rising premiums. Many cantons even consider the premium reductions as “maneuverable measures”.

This is grist to the mill of the premium waiver initiative, with which the SP is calling for an extension of the cuts. The autumn session in Bern, which starts next week, should determine whether there will be a counter-proposal. In this case too, the cantons apply the brakes, but in doing so only increase the chances of the citizens’ initiative.

This abbreviation stands for the uniform financing of outpatient and inpatient services. Today there is an important difference. Outpatient hospital treatments, which make sense for reasons of efficiency, should be fully paid for by the health insurers. The cantons pay 55 percent of the costs for inpatient treatment.

The former central national councilor and health politician Ruth Humbel therefore submitted a proposal for standardization 14 years ago. Since then, Parliament has struggled to find a solution, and once again the cantons are the brakes. They fear additional costs due to the increase in outpatient treatments and are therefore making an additional request.

In concrete terms, they demand the inclusion of long-term care, with the ulterior motive of partially burdening the health insurers with the costs. Given the aging of the population, this is an urgent problem. According to a study by health insurer Santésuisse, EFAS thus becomes a loss model for premium payers.

Everyone actually knows that there are too many hospital beds in Switzerland. Better planning and coordination would be needed, but the closure of small, inefficient hospitals has met with public resistance. Nevertheless, six eastern Swiss cantons dared to take the big step of joint hospital planning three years ago.

This spring was followed by great disillusionment. Glarus, Graubünden and Thurgau left the project with St.Gallen and the two half cantons of Appenzell. The Grisons justified the withdrawal with the application of minimum case numbers. These would endanger health care in remote valleys, the report said.

Minimal case numbers are useful for efficiency and treatment quality reasons. Observers suspect that the cantonal spirit is the real reason for the exit. According to the NZZ, Graubünden and Thurgau feared becoming the junior partner of the “overwhelming” St.Gallen and losing importance as a hospital location.

The East Swiss ‘tragedy’ makes closer cooperation more difficult. It is a necessity of the moment, also because many hospitals have shortages. “It is necessary for the cantons to reform the hospital landscape. Otherwise, the federal government will eventually force us to do so – and rightly so,” said Ausserrhoden health director Yves Noël Balmer (SP) of the NZZ.

Many hope for the federal government and the successor to Health Minister Alain Berset, including Natalie Rickli. But the cantons cannot escape their responsibility. Cantonal spirit and rapping split should not be used as a pretext for half-baked ideas such as abolishing compulsory health insurance.