Four hours of engagement at the heart of Ursula Sommer (Name lasted changed) a few weeks ago in the Zurich triemli hospital. For the 76-Year-old, this was a heavy burden. However, because of a heart no longer flap from the castle, and threatened worse consequences. The Doctors recommended her following a four-week stay in a rehabilitation clinic. Still in the hospital, the summer was learned, however, that their health insurance did not want to Finance the Swiss teachers ‘ health insurance Fund (SLKK), such a rehab. On re-consideration the request of the Doctors, the SLKK granted in the high mountain clinic in Davos for a rehab stay of two instead of four weeks.
as Ursula the summer, not recovered so quickly, requested the Doctors for an extension by a week. Again, the SLKK halved the length of visit requested: After another half week, Ursula summer, had to leave the rehab. It was only a few days, came for the most competent Doctors as a surprise. In her report, she noted that “due to the sudden exit,” a Therapy was not possible. Shortly after the dismissal, they had been exhausted for days and I have needed the help of her husband, tells summer. In the meantime, she is getting better.
The SLKK want to refer to, among other things, for reasons of personality protection to the concrete case, of any comments.
Less in-patient rehabilitation
As head of performance management at the Swiss Paraplegic centre Stefan Metzger negotiated with health insurance companies on commitments to pay for in-patient Rehas, in which also the residence costs will be financed. However, he notes, firstly, that it will tend to be more difficult for such rehabilitation stays will receive a cost reimbursement. And, secondly, that “decide individual health insurer arbitrarily”. At the same time, butcher emphasised that, depending on the health insurance significant differences. Some of the benefits generous. Other health insurer, it is but obvious, etching expensive patient increase, so they switch to a different Fund.
Other experts agree that the health insurers rehab financing have become increasingly more restrictive. To the growing costs, contributes on the one hand, pressure in the health sector, on the other hand, but also the General Trend from inpatient to outpatient treatment, is already since years. Figures from the Federal office of statistics confirm the trend: health care expenditure for outpatient Rehas between 2011 and 2016, increased significantly stronger than those for stationary Rehas.
For the Stefan Metzger referred to the arbitrariness of a good reason is: While in the case of a leg fracture, the need for medical treatment is undisputed, there are rehab stays and more room for interpretation. Often a Patient may visit shortly after surgery, independently of a physical therapy or a program for cardiac rehabilitation. If, however, these offers are far away from the apartment, if the staircase is in a multi-family house to be a stressful obstacle, the Patient is disoriented or physiotherapy must be available on weekends, is it for him to be home more difficult, as butcher explains. What is reasonable must be decided in each individual case.
“Often the rehabilitation to be justified-applications insufficient.”Sonja Wehrle, head of the hospital and care, Helsana
trust the doctors of the health insurance Fund have a significant influence on the financing of a rehabilitation. “Unfortunately, the trust doctors are often no rehabilitation experts – which complicates the decision-making occasionally,” says health economist, Willy Oggier. As President of the Association of Swiss rehab, he is familiar with commitments to pay for in-patient Rehas. Stefan Metzger from the Paraplegic center also notes that the trust in doctors often do not even for a specialist exchange of ideas are at the “difficult cases”. This made it impossible for the community to find for the rehabilitation of appropriate Decisions.
The control by health insurance companies, however, is not a bad thing – the rehab should only be financed when installed. In the elderly, it can prevent about that this rapid cases, to costly long-term care, which, ultimately, often the General public co-financed, such as Willy Oggier explained. Add to this that it is not the health insurers only for controversial Decisions, responsible. “Often, rehab be reasoned requests of the competent Doctors insufficient,” Sonja Wehrle, head of hospital, nursing, and Case Management of Helsana,.
For patients who expect a rehab stay, there is little guidance. Professionals, the health insurance act, the health care benefits Ordinance or guidelines of the trust-and insurance physicians. Some of it is difficult for a layperson to understand, a Lot of leaves so much room for interpretation. Lay people help more with the recommendations of the Berne rehab centre Heiligenschwendi. It advises, with a cost of approving the application, the following must be submitted: complete diagnosis, information on the current therapy, reasons for in-patient therapy, evidence of deficits of the patients, the need for daily therapy and the chances of success of the rehab describe.
(editing Tamedia)
Created: 28.04.2019, 18:26 PM
