The uniform financing project for ambulatory and inpatient health services (EFAS), up for vote on November 24, will not resolve the problems facing the health system, believes the SSP. The union, which launched a referendum, fears that this reform will give too much weight to insurers
EFAS (Einheitliche Finanzierung von ambulanten und stationären Leistungen or “uniform financing of ambulatory and stationary services” in French) aims to standardize the distribution key for financing care between health insurers and the cantons. This revision of the LAMal is one of the most important in the Swiss health system in 30 years.
If yes on November 24, all services, whether outpatient, hospital or provided in EMS, will be financed according to the same distribution key: a large quarter for the canton and the rest for health insurance. The Public Services Union (SSP), however, fears that this high participation in benefits will give more weight to insurers in the health system.
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“You should know that this project is the baby of the health insurance lobby,” Beatriz Rosende, central secretary of the SSP, denounced Monday in La Matinale. “It is a reform which is bad because it will transfer part of the power to the health funds to the detriment of the cantons and we believe that the health sector is important enough for it to remain under the responsibility of the cantonal authorities. “
This is a bad reform because it will transfer part of the power to the health funds to the detriment of the cantons.
“Americanization” of care
For the union, greater influence of insurers in the sector could lead to an “Americanization” of care. “Insurers in Switzerland play on two sides. On the one hand, they are obliged to provide basic insurance and on the other hand, they sell us additional insurance,” says Beatriz Rosende.
According to her, insurers would have every interest in providing “incomplete” basic insurance, in order to encourage the population to take out additional insurance, on which they can make a profit. In addition, this system would further increase inequalities in access to care, believes the trade unionist, with many people renouncing certain benefits not included in basic insurance.
The liberalization of the health system leads us towards more privatization and a system that is more favorable to people who have large means to care for themselves.
“It costs so much to ensure that we tend to take high deductibles and wait as long as possible before going to the doctor for treatment when we have little means,” adds Beatriz Rosende. “The liberalization of the health system leads us towards more privatization and a system which is more favorable to people who have large means to care for themselves.”
Consider income
Beatriz Rosende also recalls that the individual contribution to the financing of care is very high. Up to 60% of health expenses are financed directly by premiums and direct contributions, such as the deductible or co-payment. “This 60% does not take into account our income, so it has a huge weight on the middle class.”
The SSP referendum therefore proposes greater participation via taxation. “The problem with EFAS is precisely there: do we take a system where it is the tax which finances more taking into account income or do we remain in a system where it is the premiums which do not take into account the income which finance the system?”, summarizes Beatriz Rosende.
Towards an increase in premiums
According to her, these premiums could even increase further if the reform was accepted. Health funds would have to pay more than the cantons, which would have an impact on policyholders, “because health funds are our premiums”, says Beatriz Rosende. “When we reduce the cantonal share, and therefore the tax, we increase the share of premiums,” she says. “So it is an increase in health insurance premiums that is taking shape with this reform.”
>> Read also: Opponents of the reform of the healthcare financing system fear increases in premiums
When we reduce the cantonal share, we increase the share of premiums, so an increase in health insurance premiums is taking shape with this reform.
The SSP also fears a deterioration in working conditions and therefore in the quality of care in hospitals and EMS, under pressure from insurers. “We feel the burden of insurance on a daily basis to save money,” says Beatriz Rosende. “When we have 70% of costs which are personnel costs, if we make savings, it is on staff, staffing and the time available for patients.”
The trade unionist explains that such cuts would have an impact on the performance of health personnel, who are already exhausted. “You should know that poor working conditions mean poor quality care,” she says. “It’s typically a sector where you can’t do more with less.”
Tuesday, La Matinale will receive Federal Councilor Elisabeth-Baume Schneider, who supports the EFAS project.
Comments collected by Pietro Bugnon
Web adaptation: Emilie Délétroz
