Midwives are ugly: how Berset officials drive up costs

The big lament is on the agenda: on Tuesday, federal councilor Alain Berset will announce for the last time how much health insurance premiums will rise next year. This much is clear: the increase will be significant. And it is all too clear: the discussion about how to slow the rise in healthcare costs will gain momentum.

Even Berset’s officials at the Federal Office of Health (BAG) do not always play a glorious role, as the following story about mothers, midwives and the belief in gods in white shows.

But from the beginning. The Health Insurance Act dates from 1994. The article on motherhood has not been revised since then. There was a time when mothers stayed in the hospital for a long time after giving birth. At least six to eight days.

Many women now go home with their newborn baby after just 48 hours. Here midwives play an important role in the care of mother and baby. For example, they perform blood analyzes to detect jaundice. However, this role is not provided for in the law for midwives. There is a gap between law, regulations and practice.

Some health insurers have noticed this. And they started no longer covering certain costs for obstetric services because there was no legal basis. This led to inequality. Staying with the test for jaundice: mothers who stayed in the hospital longer and had the blood test done there did not have to reimburse the costs. Mothers who went home and had the test done by the midwives had to pay for it.

The BAG acknowledged that the law no longer meets practice – and encouraged the Swiss Association of Midwives to seek allies in parliament who would give the Federal Office a mandate to amend the law. The midwives did this, the Health Committee of the National Council participated and the BAG developed an amendment to the law, which will now come to parliament this week. As part of a cost savings package.

But: Berset’s officials do not restore the status quo with their proposal. They limit the competence of midwives – and pass it on to doctors.

For example, blood tests for jaundice should be reserved for doctors. So the mother has to go to the doctor’s office with the newborn. The same goes for if she needs a prescription painkiller after giving birth. If a woman has open nipples due to breastfeeding, she should also go to the doctor who will prescribe a breast pump. If the situation is acute on the weekend, the only option is to go to the emergency room.

Andrea Weber, director of the Swiss Midwives Association, sees the proposals of the BAG and the Federal Council as increasing costs: “We midwives are always cheaper than gynecologists and paediatricians.” Midwives are paid per consultation, not based on time or tests performed. In addition to the higher costs, Weber also mentions the extra effort for the already burdened doctors and unnecessary stress for mother and child.

Health politician Barbara Gysi calls the proposed law ‘absurd and expensive’. The St.Gallen national councilor is fighting to ensure the practice that has existed for two decades is correctly reflected in the law. The midwives are trained for this and have the necessary skills. She notes that in many places in the BAG there is a feeling that doctors can do everything better.

Gysi and Center State Councilor Priska Wismer-Felder also point to the shortage of skilled workers. Pediatricians and general practitioners are rare in many places. Actually, they are not keen on new tasks either. Philippe Luchsinger, President of General Practitioners and Pediatricians Switzerland, writes in a letter to the National Council members that in times of increasingly scarce resources and a lack of professionals, it is a must to divide the work wisely, optimally and cost-effectively: “It is of us From this point of view, it is logical that the work of midwives is not hampered by unnecessary restrictions. The measures, examinations and materials that midwives are allowed to use based on their undisputed competence must also be billable, without additional obstacles such as medical prescriptions.

The chairmen of Pediatricians Switzerland and Pediatrics Switzerland also called the BAG’s proposals cost-increasing in a letter. It makes no sense that a doctor’s prescription or consultation in the practice is required to take blood samples for jaundice. And: “We lack the capacity to carry out all these consultations and assignments.”

In short: The BAG wants to give doctors competencies that they do not want and for which they have no capacity.

The preliminary advisory committee still agreed with the suggestions of the administration and the Federal Council. The wind has now changed in Parliament – ​​there is talk of an “industrial accident”. And that Minister of Health Alain Berset was even able to distance himself from the suggestions of his officials in the debate. So that midwives can continue to do what they have been doing for more than twenty years – and these services are also reimbursed by health insurers.