Health expert warns urgently: ‘The situation in Swiss hospitals is critical’

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You have been following the development of the economic situation of hospitals for years. How does it look?

The situation is critical. The decisive factor for profitability is EBITDAR, that is, earnings before interest, taxes, depreciation, depreciation and rent. We include the rent because many hospitals lease the infrastructure. We believe that for a hospital to make the necessary investments in the long term, its EBITDAR should be 10 percent. Hospital profitability has been below this target value for years and has now dropped further.

What are the numbers for 2022?

We look at the annual reports of the 40 largest Swiss hospitals, which together account for around 80 percent of the inpatient market. There are currently 34 of the documents available for 2022. So far, only 4 facilities have an EBITDAR value of 10 percent or more. This is worrying. If we continue like this, a few years from now, we will have saved the hospitals just as we saved the banks today. Taxpayers will have to inject the money that hospitals lack today by increasing their equity.

Health insurance companies say: There must be pressure or hospitals will never be more efficient.

This is true in principle. Hospitals can and should become more efficient. There are still many hospitals in Switzerland and not all of them are needed in their current form. But it’s a tightrope walk and I think the financial pressure is very high right now. Given inflation, care initiatives and the development of medicine, tariffs are very low and outdated, especially in the field of outpatient care. In addition, it cannot be said that there is a cost saving. Many cantons, especially in western Switzerland, lend a large helping hand to their hospitals by increasing public services or increasing equity. So there’s just a shift in costs from health insurance companies to taxpayers. This is a zero-sum game. Also, incentives are not correct.

how?

Consistent outpatient care can save almost a billion francs. Considering the hospital cost of approximately 20 billion Swiss francs, this is very significant. The US shows how much is possible with outpatient care. Almost all orthopedic procedures are performed here on an outpatient basis.

This means that hospitals will allow patients to go home immediately with new hip joints or newly operated arms.

Of course, this is only possible if the personal situation at home is correct and the specific medical situation allows it. But certainly much more can be done on an outpatient basis in Switzerland. In order for the outpatient treatment to be settled, the fixed prices for the outpatient treatment must be higher than the current Tarmed tariffs. But that’s not the case. A hospital’s inpatient practice is more economically attractive, and not good, especially if patients have additional insurance. Tarmed, the outpatient service schedule, is completely out of date. In addition, tariffs in the field of outpatient care should be adjusted regularly, taking into account medical developments.

What about fixed tariffs?

In principle, the Swiss DRG is a good system. It takes inflation into account – with a lag of several years – and takes medical progress into account. But here, too, prices need to be adjusted upwards accordingly.

What else is there in terms of efficiency?

Many doctors and nurses are already walking on their gums. Increasing the pressure on staff further is unacceptable. Also: The pressure demanded by the health insurance companies came to the hospitals. Most hospitals go to great lengths to improve their efficiency. Many are working on innovative and more efficient processes, and a lot is happening in the digitalization space as well. For example, at Inselspital in Bern, several hundred employees from the core business are currently working on a comprehensive digitization project. It is also important that hospitals think in networks, not in silos. Here, too, we see many positive examples of cooperation, more and more collaborations and joint ventures. All this requires not only money, but also resources. So we need to take the pressure off a bit so hospitals have enough room to reshape their future.

Are more structural adjustments needed?

This is inevitable. In the future, there will be fewer hospitals coordinating their offerings more closely.

st. Gallen, Aarau and Lausanne have already built, Chur and Zurich will invest hundreds of millions of francs in new buildings over the next few years. Have the right priorities been set here?

In my opinion, a little too much investment is invested in “concrete” and a little too much in smart solutions. New buildings can bring certain efficiency gains, but I also see more potential in digital support of processes. But in the end you need both. In my view, given the lack of skilled workers, it is important that buildings be functional and not have prestige or town planning aspects.

Source :Blick