Full emergency rooms and lack of money: children’s hospitals are sounding the alarm

Children’s hospitals have been struggling with a lack of money for years. And now a federal reform threatens even more financial problems, says the Alliance of Children’s Hospitals of Switzerland (AllKidS). Together with other associations, she recently called for the suspension of a reform that provides for a new cost benchmark.

AllKidS president Marco Fischer, CEO of the University Children’s Hospital in Basel, explains in an interview why he rejects the reform, what is currently tearing a hole in the coffers of children’s hospitals – and what it looks like in the emergency room.

Last year, children’s hospitals sounded the alarm about overcrowded emergency departments and there have been complaints about the financial situation for some time. What is the current status of children’s hospitals?
MARCO FISCHER: Financially it doesn’t look good, we are suffering huge losses. We had to make huge wage increases and adjust the cost of living

Because of the shortage of trained personnel?
Yes, we feel the pressure of the labor market. At the same time, material and medication costs are rising, as are energy prices. All costs go up, but nothing happens on the financing side. The rates remain the same. This inevitably creates a hole…

Does nothing change at all?
There are currently no signs. We are now starting negotiations for next year. But it will likely take some time before an agreement is reached

The figures for 2022 were better than before.
Last year we had a special situation as a result of the wave of infections that started in the summer with RSV and flu viruses. Due to the exceptionally high occupancy rate, we have had a better year financially. But it was a huge burden on the staff. This is also why we had to respond to wages.

What is the current situation in the emergency room?
It’s relaxing. We are back to normal business operations – actually for the first time since the Corona crisis. It remains to be seen what autumn will bring. We are certainly prepared if there is another wave of infections.

The Alliance of Children’s Hospitals, together with the H+ Hospital Association and the Swiss University Medicine Association, recently called for the suspension of a planned review (see box). Why did you go public?
It is a call to show that central, university and children’s hospitals in particular are substantially threatened. They would suffer from this reform. Because hospital costs are compared as if all hospitals were the same. The cost benchmark should then be set at the 30th percentile. So they say: 70 percent of hospitals are too expensive. This assumption is a joke…

Certain correction mechanisms should be introduced, for example allowances for emergency operations.
Yes, but these corrections have not been thought through. Moreover, the hurdles to receiving the prizes are too high. This brings with it great uncertainty. And it cannot be that 70 percent of hospitals start with red figures!

The three associations opt for drastic words: the revision represents an ‘existential threat to medical care in Switzerland’. Isn’t that panic mongering?
It would be financially dramatic. A hospital must be able to invest, develop and respond to new requirements and new treatment options. If you cut out the money completely, the supply will be compromised to some extent

Is it not in the interest of those who pay premiums and taxes if efficiency is rewarded?
Of course it makes sense to reward efficiency. But with this revision that is not possible. If a hospital makes a profit because it specializes in a lucrative area, profit is not a matter of efficiency, but rather a matter of cherry picking. However, in a children’s hospital we have to cover the entire range of treatments, otherwise no one would do it – precisely because it is not profitable. In addition, we hardly have any private insurance.

It seems to be the same with every cost-cutting attempt: reforms are blocked, healthcare costs – and therefore premiums – continue to rise. Do you see any responsibility here?
We see ourselves as having a strong responsibility to use money sparingly. And we do that too. We have done our homework in terms of service efficiency. Moreover, the need for a measure in pediatrics has always been discussed twice. Of course, I also see concerns about the premium increase. But in our children’s hospitals the lemon is being squeezed

Four years ago, parliament passed a motion calling for cost-covering rates in children’s hospitals. You also had contact with federal councilor Berset. What became of it?
Since then, nothing has arrived, not a single franc. We have had a structural deficit for years. In the outpatient sector, the cost recovery rate is below 70 percent! And at this point, it looks like it will be a long time before we have a new outpatient pricing system. Everyone is shifting responsibility – the federal government to the collective bargaining partners and vice versa. And in the end nothing happens.

What should happen?
We have developed various measures. Federal councilor Berset has promised that he will support us in the collective negotiations if the new rate system for outpatient care, the Tardoc or the outpatient fixed rates, is not ready by the end of the year. But now that he is stepping down, we don’t know whether his successor will deliver on the promise.

Who should act? Would it be up to the Federal Council to reverse the interventions in the Tarmed tariff system?
Perhaps one should ask: who could act? The Federal Council could actually take action. Our greatest hope is that the negative effects of tariff interventions will be reversed

If the financial situation does not improve, what does that mean for young patients?
We have provided very good care in recent years. Our employees have put in a lot of effort. Our goal is that our patients do not experience financing problems and continue to receive optimal treatment. That is what we stand for. (aargauerzeitung.ch).