If an event is announced with the slogan “paradigm shift”, the experience advises caution. In this case, however, it is justified: the health insurance company Visana takes an interest in the Bernese Jura hospital of the Aevis Victoria Group. The hospital will in future be called «Réseau de l’Arc». So far, so unspectacular.
But the three partners – Visana, Aevis Victoria and the Canton of Bern – want nothing less than to revolutionize healthcare: In concrete terms, the inhabitants of the Jura arc will in the future be offered medical services in combination with health insurance.
Membership fee instead of bonus
Instead of a normal health insurance premium, members pay their premium to the network “Réseau de l’Arc”. The latter manages the funds and uses them to pay for all costs incurred in the clinics and practices. The doctor, on the other hand, does not charge for individual services, but receives a fixed rate per patient. The insured person no longer sees an invoice. The system is expected to be introduced in 2024.
The hospitals of Moutier and Saint-Imier, the psychiatric base with the Bellelay clinic and the medical center in Tavannes belong to the Bernese Jura hospital. The hospital also has shares in the Medizentrum in Moutier, in the central pharmacy inter-Jura, in the Bernese Jura X-ray Institute and in the radio-oncology center Biel-Seeland-Berner Jura. And “Réseau de l’Arc” wants to gradually expand its offer, for example in ambulatory care and geriatric care.
Model USA
The new business model is based on the US. Founded in 1945, the Kaiser Permanente healthcare group operates 39 hospitals and more than 700 medical practices with more than 300,000 employees, including more than 87,000 physicians and nurses. Access to this comprehensive range of medical services is available to anyone with Kaiser health insurance — that’s 12.5 million people in the United States.
This so-called managed care offer is intended to motivate all those involved, including the insured, to act responsibly – and thus save costs. The flat rate per patient would remove incentives for unnecessary treatments, leading to greater efficiency and lower costs.
“The system is reaching its limits”
That is also what is hoped for in Switzerland. Bernese councilor Pierre Alain Schnegg (59) emphasized at the media conference that rising premiums are a sign that something is wrong: “The current system is reaching its limits, it is time to renew it.”
Central National Councilor Lorenz Hess (61), chairman of Visana’s board of directors, was convinced that it would be demonstrated for the first time “that cost structures can be sustainably reduced with an integrated delivery model”. 30 percent of the costs have been saved abroad – especially because prevention is of paramount importance. The aim is that the members do not get sick in the first place.
But Kaiser has also been criticized repeatedly — whether it’s for workers’ strikes because conditions are too bad or for patients being discharged too early.
Bund is reluctant
Whether the model can go into effect as planned, however, is still in the stars. Because first it must be approved by the Federal Office of Public Health (BAG). And for this it must be ensured that it does not conflict with the Health Insurance Act.
The federal government is reluctant. According to the BAG, new approaches to cost control are generally to be welcomed. However, the model cannot yet be evaluated. “The BAG will investigate the model as soon as Visana submits it to us,” said a spokesperson.
Lots of open questions
In addition, there are still thousands of unanswered questions: Can someone who is insured with “Réseau de l’Arc” also consult doctors outside the network? Do you have access to specialists if they do not cooperate with the network? Can you go to another hospital? What about non-cantonal patients?
As Visana President Hess says, all of these questions will be looked at with the BAG. What is certain is that even those who are not members of the Reseau network can be treated at Moutier Hospital. So it is not exclusive to members.