In the Canton of St. Gallen, five smaller hospitals are facing closure. In the Canton of Zurich, the hospital Affoltern struggling to Survive, and the hospitals in Wetzikon and Uster want to merge. After the failed hospital merger in the North-West of Switzerland is unclear, as it goes on there. The Swiss hospital landscape is in upheaval.
One of the reasons is the 2012-introduced new system of hospital financing. There are only lump-sum, instead of each Spitaltag is settled. And now the next challenge: Starting this year, on an outpatient basis instead of being stationary is valid for at least six areas of operations or investigations, the principle “”. The interventions must be performed according to a default of the Covenant in one day. Knee arthroscopies, removal of varicose veins, or of the tonsils.
The operations are then billed at a different rate. For comparison: At the cantonal hospital of Baden, a meniscus surgery cost 3971 francs, if it is stationary; the same cost on an outpatient basis in 1980 francs. The tariffs for outpatient procedures are significantly lower than in the case of a treatment with a hospital stay and are fully paid by health insurance, instead of half of the cantons. “The six interventions relate to approximately 33’000burg cases per year,” says Philip summer, head of consulting in healthcare at consulting firm PWC. Summer has investigated the impact of the new scheme. This would only affect two percent of all inpatient procedures. For the cantons, a savings potential of 90 million Swiss francs arises from the fact, according to a study by the Swiss health Observatory Obsan.
Some cantons will go ahead
The list of the Federal government is probably only the beginning. According to one Monitoring above the effect of the Federal office of public health wants to decide on an Expansion of the list. Some cantons will go ahead now and set up to sixteen interventions on the list. A pioneer of this development, the Romandie. There, it has already begun years ago with the conversion. The uniform funding of outpatient and inpatient interventions should be decided in Parliament, would be removed for all interventions, the incentive to keep patients in the hospital.
Philip summer, estimates that the potential for outpatient instead of inpatient cases in the next 10 years will be significantly higher. “It could be around 200’000 today, in-patient cases in the future, without an Overnight stay in the hospital to be treated.” That would be 14 percent of all hospital patients.
regional hospitals more
hospitals with many operating, but relatively simple interventions affected are affected according to the summer of this development. The hits regional hospitals more likely than large Central hospitals. But even in the latter case, the challenges are great. “The hospitals have to rethink and rapidly, an efficient outpatient clinic can offer,” says Jérôme Cosandey, health economist at Avenir Suisse. “Many hospitals hard, large and small.” It’s not just public hospitals, and feel the change: The Hirslanden group, registered at the end of Klinik St. Anna in Lucerne at the end of January, you have dealt with from mid 2017 until the end of 2018, approximately 1000 cases on an outpatient basis instead of being stationary, and “almost all” in the red written. Because the patients go back home, have to work in a dispensary to be more efficient than a stationary clinic.
Will lead the scheme to a reduction in hospital beds? If you ask the cantons, most of the wave. Only the Canton of Berne assumes that an expanded list would lead to “profound changes in the hospital landscape”. Who asks at the Inselspital Bern, how the new rule affects the country’s hospitals, does not receive accurate information. We are aware of the challenges and will continue to expand “outpatient services and specialised infrastructure for outpatient small and create interventions,” says a spokesman. “The hospital Burgdorf. It has been created with own funds and a bond on the capital market for 111 million Swiss francs in a new bed for the house, which is also prepared for outpatient procedures.”
technological progress
For Cosandey is the rule of “outpatient before inpatient” as a result of the technological progress. “Actually, the Doctors would have had to define themselves rules, when a procedure on an outpatient basis, and when it should be stationary are carried out,” he says. Cosandey feared that the public hospitals for their owners, the cantons, the hollow of your Hand, whether it is To or new buildings or an increase in the subsidies for public services. “That would be a dangerous development,” says Cosandey. With the principle of “outpatient before inpatient” change the competitive situation. “The competitor in a hospital is not only the nearest hospital, but maybe the next medical centre, the efficient outpatient procedures performs,” he says. Thus, the most common Argument for the hospital way to the case of subsidies: namely, the provision of health care. (Editorial Tamedia)
Created: 08.04.2019, 08:37 PM
