Hospitals are going bankrupt: These are a recipe for financial misery

The most recent example: Shortly before Christmas, Glarus Cantonal Hospital announced it would cut 36 staff, reduce the number of beds and waive any cost-of-living adjustments. Like many other hospitals, the hospital in Glarus is colored red.

Romans work less efficiently

Margins have been falling for years. Hospitals don’t make enough money. If profits shrink or turn into losses, there will be no money left to invest. For example, in more efficient processes or digitalization.

What’s striking: Margins in French-speaking Switzerland are even lower than in German-speaking Switzerland, at around 3.7 percent, according to consulting firm PwC. This is also related to the fact that the public sector in French-speaking Switzerland covers hospital deficits more generously than in other cantons.

“Current tariffs do not cover the costs. Especially in the field of outpatient care, where 30 percent is very low,” says Anne-Geneviève Bütikofer, director of the H+ hospital association (51).

Problem: Inflation and a shortage of skilled workers, who often have to compensate with expensive temporary employees, worsen the financial situation.

Cost driver technical progress

Hospitals will at best shake their heads if they want to impose higher rates on health insurance companies. Hospitals account for about 35 percent of the 40 billion francs in healthcare costs charged to basic insurance. If health insurance companies increase tariffs too much, it will have direct consequences for premium payers.

Another problem: In recent years, many clinics have invested in new equipment and invested large sums of money. “No hospital wants to fall behind the competition,” says Tobias Müller (37), a health economist at Bern University of Applied Sciences (BFH). “This means that the density of X-ray machines in Switzerland, for example, is higher than anywhere else in the world.”

This leads to an increase in costs as well as medical performance. “Medical-technical progress is often a cost factor,” says Rolf Gilgen (65), who works as a consultant and is currently interim head of the Hirslanden Clinic in Aarau. “You can detect more health problems with new devices.” More are treated accordingly. The increase in volumes increases costs.

“But,” says Gilgen, “better diagnoses, treatments and medications also lead to fewer chronically ill people, which saves costs. And better processes can help reduce inefficiencies.”

“Switzerland has one of the best and most efficient healthcare systems,” explains Bütikofer. But the longer it lasts, the more priceless it becomes. “We must learn to downsize,” says Glarus Hospital director Stephanie Hackethal, 50, in a guest article on industry portal Medinside.

This could help the hospital system

So, what could be the prescriptions to shrink the hospital system to health? There are no miraculous cures, but there are suggestions.

• Specialization and concentration: “We are very well equipped in terms of beds and hospitals,” says Müller (37) and Bütikofer says, “Not every hospital needs to offer all procedures and treatments.” However, the goal should remain the provision of equally good health care in all areas.”

Müller adds: “As the number of cases increases, the medical service becomes better and the doctors’ routine becomes better.” This is true for major medical centers: “Concentration will end the medical arms race.”

• Cantonal coordination and closures: “In the end, the only thing that matters is closing the locations,” Gilgen believes. Problem: To do this, many cantons will have to jump out of their shadows and pool their hospital capacities. “There is very little interaction between cantonal borders,” says Gilgen. Bütikofer is more optimistic: “More and more hospital regions are being created and cooperation is improving.”

Two problems remain: In some cantons, the biggest employers are hospitals. “Nobody wants to be the big job killer,” Müller says. In addition, many family physicians sent their patients to the nearest hospital; It may not be the best or most efficient hospital. “Structural regulations can strengthen patients’ personal responsibility,” says Müller.

• Eliminate the skilled worker shortage: The lack of qualified personnel will lead to the restructuring of the hospital environment. All experts agree on this issue. “Skilled worker shortages put a lot of pressure on hospitals, for example by increasing wages or closing beds,” says Gilgen. What increases financial pressure: costs increase or income decreases.

Many clinics and locations – not all survive

Not all of the recipes are actually new: “When I started as a manager at Waidspital in Zurich in 1998, similar questions were already on the table,” says Gilgen, tempering expectations for quick solutions. “There will be no big trash.”

There are currently 278 hospitals in Switzerland, divided into 595 locations. Of these, 101 are general hospitals and 177 are private clinics such as rehabilitation centers or psychiatric hospitals. Not everyone will survive the next few years.