Fee analysis in hospitals: It is not the care that is expensive, but the management

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Swiss hospitals are in a bad financial situation. “Current tariffs do not cover the costs,” said Anne-Geneviève Bütikofer (51), director of the H+ hospital association in Blick this week. Result: Many clinics make losses and some even have to go out of business.

On the expenditure side, rapidly increasing wage costs are an important problem. Figures from the Federal Office for Public Health show: From 2012 to 2021, hospitals’ personnel costs increased by a third, from 15.7 to 20.7 billion francs.

But as an analysis by Blick shows, the additional funds are not just spent on more doctors, nurses and physical therapists. Annual reports of individual hospitals make clear that additional spending on administrative staff also has a significant impact. Compared to pre-corona 2019, administrative compensation expenses increased disproportionately at many large healthcare providers.

For example, St. At the Cantonal Hospital St. Gallen, personnel costs increased by a total of 7.6 percent between 2019 and 2022. Administrative staff salary costs increased by 29 percent. Therefore, management recorded a greater increase in costs in absolute terms than doctors and nursing staff.

A spokesman said the increase was “largely” due to St. He explains with “major structural projects” such as the implementation of a new clinical information system in all four hospital networks in the canton of St. Gallen. “This resulted in additional temporary project-related expenses, including in the areas of IT, human resources and corporate development.”

Wage costs 12.7 percent more for management than in 2019

Sounds similar from Bern. A spokesman for the Insel Group says the increase in management is mainly explained by “increased staffing requirements due to large-scale projects lasting several years, such as the implementation of the new clinical information and control system in March 2024.”

Administrative wage costs for Bernese people amounted to 157.7 million francs in 2022; This figure is 12.7 percent more than 2019. For comparison: Personnel costs for nursing staff increased by only 3.7 percent over the same period.

Administrative expenses at the University Hospital Zurich (USZ) have also increased at an above-average rate recently. This is also confirmed by the restructuring: “USZ – like various other large hospitals – is in a general renovation phase,” says a spokesperson.

This affects not only the structural infrastructure, which has not been significantly adapted since the 1970s, but also the need for investment in digitalisation. “This involves establishing project teams to be able to plan and implement major projects.”

Additionally, USZ cites “administrative and legal requirements” as the reason for expanding the administration. An argument also put forward by H+ director Bütikofer: “The healthcare system, and especially the hospital and clinic sector, is a highly regulated area.”

“These additional duties are not covered financially.”

Hospitals and clinics must comply not only with national requirements and legislation, such as the introduction of electronic patient records, but also with cantonal requirements.

“Connections are extremely complex and require in-depth specialist knowledge,” says Bütikofer. This leads to more personnel costs. “But these additional tasks are not funded, which further complicates the situation for hospitals.”

According to Bütikofer, hospitals are making “huge efforts” to make their management as efficient as possible. “But this also requires significant investments, especially in IT infrastructure.”

It will take years for these investments to pay off, and hospitals will have to draw on their resources in the meantime.

Source :Blick