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The loss of the HFR is mainly due to inflation, wage indexation and an unusually sharp drop in activities during the hot season. The inpatient sector has suffered, while the outpatient sector is progressing.
Dark clouds hang over the finances of the HFR, which has suffered from inflation and a drop in summer activity in 2023. © Charly Rappo-archives
Published on 04/26/2024
Estimated reading time: 4 minutes
While the 2022 accounts suggested an improvement in the situation, the 2023 figures from the Friborg Hospital (HFR) have the effect of a cold shower. The deficit, estimated at 27.9 million francs in the budget, ultimately amounts to 36.4 million, according to a press release. The main reasons are inflation, wage indexation and an unusually strong decline in activities between May and August. “We are worried,” admits the general director of the HFR, Marc Devaud. There is a long way to go to find the best formula, but we are fighting.” The deficit has never been so high, even if the 2021 figures must be taken with a grain of salt, distorted by significant aid linked to Covid-19.
In 2023, HFR treated more than 22,300 inpatient cases in acute care and rehabilitation departments. This is less than expected and has had an impact on the accounts. This dip in activity is difficult to explain. This could be a consequence of Covid-19 which has led to numerous deaths among vulnerable people. “This phenomenon was seen in other hospitals, although it was not as strong everywhere. For us, it was a first,” relates Marc Devaud.
Closed services
The HFR will take this new trend into account. Beds and even services could be closed in the event of a reduction in activity. “We are going to make the system more flexible. But it is a risk, because sometimes the activity remains, in particular because of family doctors’ vacations,” explains the general director. Jobs are not threatened. Staff will be encouraged to take vacation or compensate overtime during these periods.
On the outpatient side, activity is up 7% compared to 2022, in line with expectations. Turnover saw a slight increase of 0.6% to reach 559.9 million francs.
“For each outpatient consultation, coverage is insufficient by more than 20% on average”
Philipp Müller
No catch
Inflation and rising wage costs were expected. But their consequences are greater than expected. The HFR estimates that the indexation of salaries and the level effects, decided by the State, represent 13.27 million. Some other 10 million are linked to higher prices. On these 23.3 million, the HFR has no control. The prices negotiated with insurance companies do not take these developments into account. “For each outpatient consultation, the coverage is insufficient by more than 20% on average compared to the cost of the service,” estimates Philipp Müller, vice-president of the board of directors.
The board of directors and management do not remain inactive. “For several years, we have implemented measures to plan the patient’s discharge from the start of their treatment,” explains Philipp Müller. The average length of stay could be reduced. But the HFR continues to suffer from waiting cases, these patients who remain hospitalized for lack of space in EMS or home care.
Containing the payroll is a priority: “We are intensifying the work of controlling the number of FTEs and strict compliance with the budget envelope in a context of growth in activities,” adds Philipp Müller. In particular, we want to slow down the automatic replacement of staff by temporary workers in the event of illness, with the exception of essential healthcare positions.” Among the good news, the absenteeism rate increased from 6.8% in 2022 to 6.6% in 2023.
“The canton plans to absorb this deficit, as has been done elsewhere”
Marc Devaud
The cumulative deficit of the HFR now amounts to 95.7 million francs. It is expected to increase further, while the 2024 budget forecasts a loss of nearly 30 million. “The canton plans to absorb this deficit, as has been done elsewhere,” says Marc Devaud. But we must first show that everything is done in terms of efficiency.” The Ebitda margin, which measures self-financing capacity, is now negative (-2.9%). It amounted to 3.32% in 2022.
Vote in sight
Maintenance and repair costs increased by 19.1% compared to 2022. The dilapidation of the cantonal hospital is one of the reasons. To maintain current structures and look to the future with serenity, HFR officials consider the support of 175 million from the canton essential, on which the people of Friborg will vote on June 9.
For the Public Services Union, the poor situation of the HFR is due to insufficient financial contributions from the State. He calls for reworking the counter-project to the H24 initiative, in order to offer better conditions to the hospital. “We need a counter-project which gives this institution the means to stabilize its financial situation, avoid cost-saving measures and improve the working conditions and salaries of staff,” according to a press release released on Friday.
