The Swiss population will vote on November 24 on uniform financing of healthcare. The EFAS reform intends to finance all basic insurance services, ambulatory, hospital or provided in EMS, according to the same distribution key: 26.9% borne by the cantons, 73.1% borne by insurers. Deciphering the Jura issues.
No major impact for Jura if accepted
Currently, outpatient care is 100% covered by insurers. With the reform, the canton of Jura will cover 26.9% of these costs, so it will pay more than today. By outpatient care we mean, in a doctor’s office, with a therapist or in hospital without an overnight stay, in particular. Hospital care, provided at the hospital with an overnight stay, is currently 55% covered by the canton of Jura. With the reform, this share will fall to 26.9%, the canton will pay less. And finally, long-term care, in EMS or at home, will continue to be covered by around a third by the canton, status quo with the reform, according to the Jura Public Health Service (SSA). The goal is to encourage outpatient treatments to lower costs and premiums. Currently, insurers have no interest in encouraging this type of care, which they cover 100%.
This reform, if accepted, would however not have a major impact in financial terms for the region. According to the Jura Public Health Service, the financial impact of the reform would even be practically zero for the canton. The increase in the coverage of outpatient costs by 26.9% and the reduction in hospital costs by an almost similar proportion should balance each other out, according to cantonal estimates.
Doubt remains over the implementation of the reform for the SSA
In practice, insurers will pay the full amount of services and then invoice Jura for its share, 26.9%, for patients domiciled in the canton. Insurers, in possession of all the data, will thus be given more power, according to the Jura Public Health Service. It will therefore be necessary to implement a system for exchanging information and data between insurers and the cantons. With what security? With what guarantees of transparency from insurers? So many questions which remain unanswered for the moment, according to the canton. /mmi-tna
