The Swiss population will vote on November 24 on the uniform financing of healthcare. A battle that promises to be tough. But for Federal Councilor Elisabeth Baume-Schneider, who defends the project, the proposal submitted to the people is “correct” and must make it possible to show that the system is “reformable”.
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) says it fears that this high participation in benefits will give more weight to insurers in the health system.
An argument called into question on Tuesday by Federal Councilor Elisabeth Baume-Schneider, who wants to “play down” this idea that EFAS would give more power to health funds. “The prices will always be defined with the partners and it is the Confederation which decides on the catalog of services,” argues the head of the Federal Department of the Interior in La Matinale.
With this reform project, insurers are making their entry into the financing of EMS services, although they are, today, absent from this area. So, won’t they impose tariffs?
We managed to bring the partners around the table and they reached agreements
Asked about this, the Jurassienne elaborates: “If we had this fear, we would not have all the healthcare providers, whether the Federation of Swiss Doctors (FMH), the umbrella organization of hospitals (H+) and now Pro Senectute , who are in favor of EFAS. Reasonably, I think everyone realizes that the status quo is not possible.
For Elisabeth Baume-Schneider, this reform is “extremely important” insofar as it brings clarity and transparency in terms of financing. “It is not a panacea, but it is an important step which also shows that the system is reformable. We managed to get the partners around the table and they reached agreements,” explains the socialist.
An effect on health premiums?
If accepted by the Swiss people, would the entry into force of EFAS make it possible to reduce premiums? Since insurers and the cantons finance all services together, they will have a common interest in encouraging the most judicious medical treatment, also argues the Minister of Health.
The new method of financing makes it possible to better coordinate care and therefore avoid hospitalization or delay admission to EMS. All the players would finally be together on the same boat, therefore mutually interested in overall cost control”, the pro-EFAS committee recently added. According to them, the reform will save 440 million francs per year. And therefore, potentially , to reduce premiums.
It is important to say that we are towards a downward trend
“I think it is extremely important to say that we are moving towards a downward trend, rather than being systematically towards an increase in costs”, reacts the former state advisor, who also explains that in the event yes, two billion francs would be covered by the cantons, thanks to premium payers.
The population would, however, be affected by an increase in their share in the event of hospitalization. “It will cost more, but in a case where I am doing an operation that I could have done on an outpatient basis and that I would ultimately have done on a stationary basis,” she explains.
A no would be “serious”
For the head of the DFI, a no would be “serious”. “This would mean that the system cannot be reformed and that we are satisfied with the way it works, with increases in premiums and with fewer incentives for outpatient care,” she further notes.
Elisabeth Baume-Schneider nevertheless praises the Swiss health system. “We can be proud of this system, but it has a certain cost and I believe that we are responsible for ensuring that this cost is bearable for premium payers. With EFAS, there is a way of doing country plus cantons, that is is also more equitable because it is paid with tax. It is more coherent because, currently, income is not taken into consideration in any way,” she concludes.
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Comments collected by Pietro Bugnon
Web text: Jérémie Favre
