Overview

Outpatient treatment and the other side of the coin

Guido Klaus

Ever more outpatients than inpatients. What is good for the healthcare system as a whole cannot relieve the burden on premium payers if outpatient and inpatient treatments are not funded the same.

Medical progress makes it possible to treat many more ailments on an outpatient rather than an inpatient basis than before. This saves costs for the healthcare system as a whole. But Helsana's expenditure report shows an above-average increase in the costs of outpatient treatment in hospitals and by doctors: The costs for outpatient treatment by doctors rose by 37 per cent between 2008 and 2015, while the costs for outpatient treatment in hospitals rose by as much as 52 per cent (see table).

The rise in costs is partly explained by the increase in Tarmed tax points per patient, which means that doctors carry out and charge for more procedures. According to Helsana's report on “Expenditure trends in healthcare 2016”, for Switzerland as a whole the tax points per patient rose by 7 per cent in hospitals from 2012 to 2015, for general practitioners by 10 per cent, and for specialists by 14 per cent.

Political measures to contain this trend such as the moratorium on licences to practice medicine do not seem to be particularly effective. And no such measures apply to outpatient treatment by hospitals. The Federal Council's recent intervention in the Tarmed outpatient tariff should lead to savings of several hundred million francs, but this still does not change the fact that the Tarmed system as a whole needs to be urgently revised. This poses a challenge to the tariff partners.

Premium payers will only benefit from “outpatient before inpatient” if the funding is the same

Although “outpatient before inpatient” increases outpatient costs, it saves costs for the system as a whole because outpatient treatment is usually considerably cheaper than inpatient treatment. But with the current funding system, the savings do not benefit the premium payers. While the local canton assumes 55 per cent of the costs of inpatient treatment and 45 per cent is borne by premium payers, premium payers are responsible for 100 per cent of the costs of outpatient treatment. The solution is obvious: for premium payers to also benefit from the shift from inpatient to outpatient treatment, the funding system should be the same for both types of treatment - based on a fixed co-payment key for the cantons and the insurers. This is the only way for premium payers to benefit from the shift from inpatient to outpatient treatment - through lower insurance premiums and a system that is made more efficient by removing an important disincentive.

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