Fribourg: 29% of hospitalizations take place in another canton. Is it serious doctor?

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In 2022, three out of ten hospitalizations of Friborg patients took place in another canton. As the people vote on June 9 on support for the Friborg Hospital, the question arises: should we be worried about this exile?

These are the five cantons with a university hospital (Geneva, Vaud, Bern, Basel and Zurich) which export their patients the least. © Keystone/Photomontage: Florence Cerouter

These are the five cantons with a university hospital (Geneva, Vaud, Bern, Basel and Zurich) which export their patients the least. © Keystone/Photomontage: Florence Cerouter

Published on 05/10/2024

Estimated reading time: 4 minutes

In 2022, 14,400 cases of hospitalization of Friborg patients took place in another canton, mainly Bern (9100) and Vaud (3700). This is shown by the latest figures from the Federal Statistical Office (FSO), also including psychiatric cases or rehabilitation. Indeed, since 2012, the legislation has allowed the free choice of hospital, however under certain conditions. The costs are shared: 55% borne by the canton of residence, the remaining 45% for the insurers. Concretely, nearly 29% of cases of hospitalization of residents of the canton of Friborg therefore take place outside the cantonal borders. And this share is constantly increasing, albeit moderately. As the people vote on June 9 on local emergencies and support of 175 million francs for the Friborg Hospital (HFR), this question arises: should we be worried about this exile?

These figures must nevertheless be put into perspective. Firstly, it should be noted that in an intercantonal comparison, Friborg is rather in the middle of the ranking, neither worse nor better than a canton of comparable size such as Thurgau for example (see infographics). Quite logically, it is the five cantons with a university hospital (Geneva, Vaud, Bern, Basel and Zurich) which export their patients the least. Next, it is important to note that most cantons have seen the share of hospitalizations outside the canton increase in recent years, even slightly. Finally, the geographical position of the canton of Fribourg, between the major hospital centers of Bern and Vaud, makes it particularly prone to an exodus of its sick and injured.

Many designs

According to Marc Devaud, general director of the HFR, the reasons that could push a patient to cross the cantonal border are numerous. He elaborates: “The majority of hospitalizations outside the canton are either the consequence of the referral of a patient by his treating doctor for reasons specific to him or of a personal choice of the patient. Note that hospital planning did not include certain services in Friborg hospitals due to lack of critical mass or specialists. It is therefore normal that the patient is then directed to a site offering medical care missing from the catalog of services, for example cardiac surgery. On the other hand, the definition of services resulting from highly specialized medicine (MHS) requires the canton to delegate certain interventions (pancreatic surgery, esophageal surgery, etc.) to centers carrying out a minimum number of interventions per year.”

Moreover, the phenomenon varies greatly from one discipline to another. In a recent report devoted to the canton of Fribourg, the Swiss Health Observatory (Obsan) notes: “Generally speaking, the share of hospitalizations outside the canton is higher for several areas of care. For example, it is around 40% for orthopedics (39.6%), for heart-related care (41.9%) as well as for otolaryngology (44.4%). . It even reaches 80.7% for neurosurgery and 89.7% for ophthalmology” (2019 figures).

“This situation does not necessarily cost the canton of Friborg more”

Claudine Mathieu Thiébaud

But concretely, what are the consequences if patients are hospitalized elsewhere? Head of the Cantonal Public Health Service, Claudine Mathieu Thiébaud deciphers: “This situation does not necessarily cost the canton of Friborg more. Of course, also in the perspective of a new hospital center in Friborg by 2032-2033, efforts must be continued so that the population of Friborg uses as a priority the healthcare offer in the canton, except of course for the highly specialized medicine where the canton is bound by an intercantonal agreement.” Because in the price of packages per case applied to acute care, 10% is dedicated to investment. And if the State of Friborg must pay 55% of each hospitalization of Friborg patients, as much as this serves to invest in its own territory.

Task force Standby

This is why, at the end of 2017, the canton announced the creation of a task force to look into the problem. What about today? Claudine Mathieu Thiébaud explains: “The situation that prevailed in 2017 has evolved considerably. There task force set up in 2018 and made up of the leaders of Friborg hospitals and representatives of the canton’s doctors, was put on standby at the beginning of 2020 with the appearance of Covid-19. However, in the catalog of measures identified, some have been put in place but without being subject to regular monitoring. Thus, to mention only the most important, information on information platforms dedicated to patients has improved, reinforced communication between the HFR and treating doctors has been initiated as well as a strengthening of links between attending physicians and primary care physicians. However, the results remain difficult to measure.”

Friborg wants to keep its patients

At the time, a study commissioned by the State of Friborg also showed that the districts with the highest rates of extra-cantonal hospitalizations were Lac and Singine. In this regard, Claudine Mathieu Thiébaud indicates in particular that a mandate has been given to a design office to develop new avenues for strengthening care in the German language. “Representatives of the HFR and the German-speaking regions were involved in this work and the results are expected this fall,” notes the head of the Public Health Service. Marc Devaud adds: “The development of new services on the HFR Tavel site should make it possible to initiate a new dynamic of collaboration which should benefit the German-speaking population of the canton.”

A crucial issue for Friborg

On June 9, the people of Friborg will vote on several items related to health care in the canton. The initiative for 24-hour local public hospital emergencies was launched by a movement of citizens dissatisfied with the new direction of district hospitals. She calls for the reopening of 24-hour emergency services in Tavel and Riaz. In order to respond to concerns, the Council of State and the Grand Council have concocted a counter-project containing seven measures aimed at ensuring adequate care throughout the territory.

They also submit to citizens a decree relating to an amount of 175 million in order to support the investments of the Friborg Hospital. A guarantee of 105 million should allow the HFR to continue its investments in favor of renewal, innovation and improvement projects on current sites. A loan of 70 million is intended for studies linked to the construction of a new hospital. Freedom devotes a series of articles to these different objects, to read in the newspaper and at any time on the laliberte.ch website.

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