The left and the unions are fighting health care reform with a referendum: against even more power for health insurers

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It is the largest health care reform in recent years: in the future, the health care benefits of the mandatory basic insurance must be financed ‘from a single source’.

Nowadays it is like this: outpatient services are billed entirely through the health insurer. So if someone has their broken arm plastered in the hospital, the health insurer pays the bill. However, if someone has to spend the night in the hospital after an operation, we call this inpatient treatment. The health insurer will then reimburse a maximum of 45 percent and the canton a minimum of 55 percent of the costs.

This cost allocator creates false incentives. The cantons have little interest in intramural treatment, which they have to co-finance. Conversely, outpatient treatments are considerably cheaper, but they are entirely at the expense of health insurers and therefore premium payers.

The reform initiated in 2009 by former centrist national councilor Ruth Humbel (66) was intended to solve this dilemma. The basic concept is simple: all treatments are declared via health insurance. And the cantons now pay a fixed share. For the new distributor to be cost neutral, the cantons must cover just over a quarter of the total costs.

VPOD has decided on a referendum

But the template is on the edge. Leftists and unions are bothered by the fact that billing is now handled only by health insurers and that the cantons should hand over control of the bills. “With uniform financing, health insurers gain even more power,” complains union president Pierre-Yves Maillard (55). “In addition to 35 billion in bonus money, they would also manage 11 billion in taxpayer money in the future!”

Even if one hopes to achieve greater efficiency, no one can guarantee a cost-saving effect. “This reform is not current,” said the new Vaud SP Council of States. He does not yet want to comment on a possible referendum.

Yet it is already clear: a referendum from the trade union side is a foregone conclusion! The public service union VPOD, which also represents health workers, opposes the proposal. “We are against the privatization of healthcare financing and will accept the referendum,” says VPOD Secretary General Natascha Wey (41). The proposal would result in the loss of democratic control by the public sector. “If insurers set rates, cost pressure on employees will increase, which will inevitably lead to a deterioration.”

Crashing into parliament yet?

It remains unclear whether a referendum will be necessary at all. Because the bill threatens to crash in parliament during the winter session. It is now clear that long-term care will also be included in the new form of financing. What is controversial, however, is when. With increasing life expectancy, costs are likely to rise significantly – and with them the premiums if the cantonal contribution is not regularly adjusted.

An unexplained difference also causes problems: the National Council wants to abolish the patient contribution to healthcare of 23 francs per day, but the responsible Council of State Committee is against this. The committee warns that this would lead to additional costs of half a billion francs. Middle and high income earners who are not entitled to additional benefits would particularly benefit from the abolition.

Up to 150 million more

Another bottleneck is compensation for so-called contract hospitals. These are hospitals that do not appear on the cantonal hospital lists, but have concluded contracts with health insurers. The National Council wants these to be financed more from basic insurance. The Council of States opposes this because it would mean an additional burden of 100 to 150 million francs for premium payers.

Center councilor Erich Ettlin (61) hopes that the Council of States’ variant will prevail and survive the final vote. “A failure in parliament would be a capitulation and an acknowledgment that we can no longer make major changes to the health care system.” For Ettlin, a uniform financing system is only a preparation for a more important step: “The goal is integrated care,” he makes clear. “This is the only way we can create real savings potential.”

SP man Maillard, on the other hand, has a different focus: “After the premium shock, there is now an urgent need to limit premiums and take effective measures regarding rates and drug prices.”

Source:Blick