Years of litigation over failed negotiations: Rate disputes between hospitals and health insurance companies

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As a rule, health insurance companies and hospitals negotiate standard costs of treatments with each other. Collective bargaining partnerships are characterized by disagreements over prices and the goal of shaking hands after negotiation.

However, the burden of this model is heavy. Hospitals are seeking higher tariffs to cover rising costs. Insurers insist that service providers be more efficient. If no agreement is reached, the cantons will have to set the tariffs; The final say usually belongs to the Federal Administrative Court.

With the increase in prices, the tariff dispute has greatly intensified. Over the summer, some hospitals terminated their contracts with health insurance companies and insisted on renegotiating rates. St. “In many industries it is normal for inflation to be at least partially passed on to customers, but for us this is completely unthinkable,” says Stefan Lichtensteiger, CEO of Cantonal Hospital St. Gallen.

St. Collective bargaining in St. Gallen failed following the termination of the contract. Now it’s the canton’s turn. It will likely take years for the new rates to become legally binding. Currently, service providers bill according to a schedule called work rate.

If the final tariff is lower, the difference must be refunded to the insurer. “This is no longer a collective bargaining partnership,” Lichtensteiger says, “and the situation is completely deadlocked.”

Hospitals are under pressure

It seems that many hospitals now have the same feelings as his cantonal hospital. “Currently, collective bargaining is failing more than ever,” says Anne-Geneviève Bütikofer, director of the H+ hospital association. This increases financial pressure on hospitals that are already in a precarious situation.

The hospital association points out that the previous partnership in developing tariff structures worked well. But agreeing on specific prices is becoming increasingly difficult. The Swiss Conference of Health Directors (GDK) is also alarmed that cantonal governments have to set more tariffs: “GDK calls on collective bargaining partners to come to the negotiating table and sign collective agreements.”

Rolf Zehnder thinks that both sides have a duty to get closer to each other. “It is clear that both partners are still immature,” says the CEO of Spital Thurgau AG. In July, Zehnder warned in “Tages-Anzeiger” that insurers were in the process of saying goodbye to the partnership. But along the way, he again noticed more flexibility.

Industrial union steps in

Spital Thurgau AG has also terminated the collective agreements and negotiations are just beginning. “If the clearly efficient hospitals in Thurgau no longer receive cost-covering tariffs, then the health insurance companies will actually become the gravediggers of the collective bargaining partnership,” says Zehnder.

Meanwhile, health insurance industry association Santésuisse sees no reason to worry. There is no increase in unsuccessful negotiations in the inpatient sector, upon request it is stated that “for the most part, collective bargaining agreements continue to be successful”. The situation is different in outpatient treatment tariffs, and there is an increase in the rates determined by the cantons. According to Santésuisse, service providers are responsible for this situation due to a “lack of data” on costs. I

Source :Blick