Interview with Beat Walti, President of Swiss healthcare companies (Ospita), on the publication of Ospita’s Activity Report 2024, which can be downloaded in DE, FR, IT
What are the various crises facing the private hospital sector in Switzerland?
Twelve years ago, the so-called new hospital financing system came into force, which aimed to expose inpatient service providers to greater competition for quality and efficiency by introducing a DRG system. The reform had the potential to align healthcare in Switzerland more comprehensively with the needs of the population than before. Entrepreneurially agile hospital providers could have developed new, for example integrated services and positioned themselves in the market with measurable quality and thus also grow.
The revision of the Federal Law on Health Insurance (LAMal) that took place at the time rightly made no distinction between private and public care providers. But over-regulation and restrictive planning on the part of the cantonal and federal authorities nipped what was originally a welcome reform in the bud: the cantons have since extended their powers of detailed regulation through hospital lists and outpatient authorisation control into a static corset. The Confederation, for its part, has also focused on the level of premiums and restrictive directives, ensuring that the tariff partnership is seriously weakened, if not completely blocked. There is no longer any room for quality and cost competition.
In some places, crisis-like events are now occurring as a result: hospital wards have to be closed due to a shortage of specialists, emergency departments are systematically overloaded, public hospitals have to be subsidised with hundreds of millions of francs of taxpayers’ money, and so on.
Why is this? The current situation shows that the cantons’ multiple roles eliminate competition and lead to inefficient structures. It is time to clearly define roles and responsibilities and to create a transparent healthcare area that is open throughout Switzerland, as the KVG envisages in principle.
What recommendations does Ospita make?
A decisive step towards a modern Swiss hospital system is the opening up of the hospital market. The cantons should withdraw from their role as owners of hospitals and concentrate on their role as health authorities, granting hospital licences according to clear quality criteria.
In addition, a standardised basic offer should be defined throughout Switzerland, which must be accessible within 100 km of the place of residence, even from peripheral regions.
All hospital services above this threshold should be provided by those healthcare companies that are successful in the market thanks to specialisation, very high case numbers and high efficiency.
Such a clear definition of roles and responsibilities requires the pro-competitive forces in the healthcare system to work together.
In recent years, it has been too easy for those players who see the state as a monopoly provider of healthcare to divide us up. Various new appointments in authorities and associations now offer the opportunity to focus on the big picture again and initiate reforms that promise real added value for people. Ospita is continuing to work on this.
