“The Bundesrat must respond”

Mr. Engelberger, how bad is it in the Swiss children’s hospitals right now?
Lukas Engelberger: Healthcare in general is in a highly stressed situation. This is a phenomenon of the late phase of the pandemic. It may be the reason for the intense rise of the RS virus. The children had fewer contacts during the pandemic and may therefore have been unable to properly activate their immune systems.

Nursing staff also fall ill more often, which increases the staff shortage in hospitals.
This is very stressful for the employees. I fully understand that you are now drawing attention to your predicament. And I am grateful to them for their efforts.

Children’s hospitals are inundated with emergencies. These are outpatient treatments – an area that accounts for most of the work in these hospitals. But it causes them huge financial losses. Who is responsible for this?
The outpatient sector is indeed underfunded. Because the Tarmed rate system still applies. This has become obsolete and was further shortened by the Federal Council in 2018. This was at the expense of children’s hospitals. The rates do not take sufficient account of the fact that the treatment of children is significantly more complex than that of adults. At the time, the GDK spoke out in favor of keeping the children’s section out of the cuts.

Without success.
Unfortunately, the Federal Council has not. The new tariff system Tardoc could greatly improve the situation in children’s hospitals. However, its implementation has been delayed because the collective bargaining partners have not agreed on a common solution.

What does this precarious situation mean for the cantons?
They spend tens of millions each year to support children’s hospitals. You are therefore very interested in the collective bargaining partners who continue with the Tardoc. But the Federal Council must also respond.

How?
There’s a proposal on the table with Tardoc. It’s not perfect yet, but the conference of health directors has been proposing for some time that it be approved — conditionally until the methodological shortcomings are corrected. The Federal Council should take this step now because the delayed rate replacement is a central part of the problem. The Federal Council may also reverse the Tarmed cuts it announced in 2018.

So there is no shortage of room to play.
From the point of view of the cantons, stepping into the breach every year and paying subsidies for outpatient services cannot be a permanent situation. The Health Insurance Act prescribes that all well-executed services must be reimbursed on a cost-covering basis, including in children’s hospitals.

The cost brake in healthcare is not working properly and premiums are rising. Isn’t it paradoxical that those children’s hospitals that do not offer unnecessary and overpriced services are bleeding?
Not only children’s hospitals are bleeding. Take a look around the geriatric medicine department, the emergency department or the psychiatric department. The pressure is great in many areas. It is very clear that we cannot expect full performance of the healthcare system while expecting stable costs.

How to solve the problem?
Ideally, we start by consuming health services more modestly. Nowadays, for example, the aid stations are used very quickly. Also in cases where a visit to the general practitioner would be possible. We should take more responsibility for ourselves. Switzerland is not a country that wants to over-regulate the healthcare system with regulations.

And politics is leaning back?
On the contrary, it should continue with the forthcoming reforms. The planned uniform financing of the health care system is a good structural step that removes false incentives. And, of course, the tariff reforms must now be implemented as soon as possible.