|Implemented in this survey?|
The failure of the second revision of the Health Insurance Act, decreed by the Swiss parliament in December 2003, has pushed the Federal Council to adopt a strategy of unbundling. The new project of reform retraces the one rejected by parliament in its contents, but subdivides the legislative intervention into 6 small packages, which will have to be approved singly by parliament and which will be treated with the accelerated legislative procedure.
In December 2003, after a two long years of discussion, the Swiss Parliament rejected the second revision of the Health Insurance Act. The Federal Council, when analysing this result, reached the
conclusion that the negative outcome of the parliamentary ballot did not put doubt on the strategic lines of the reform, but rather on the process of decision-making. In fact almost all the
proposals included in the second revision of the Health Insurance Act, if taken singly, won the support of the majority of the members of parliament. For this reason the Federal Council decided not
to modify the lines of the reform but to change the approach.
The main novelty of the project presented at the end of the month of February 2004 consists, in fact, of unbundling. The main aspects of the second revision of the Health Insurance Act are proposed again, with minor changes, but instead of being integrated into a single draft bill they are now subdivided into small legislative packages, which will have to be approved one by one by parliament and which will be treated with the accelerated legislative procedure.
The new project of the Federal Council is subdivided into two distinct legislative acts, also from the point of view of time; overall these contemplate 6 reform proposals of the Health Insurance Act, to which a new draft bill concerning long term care financing is to be added:
The working out of a new draft bill concerning the reorganization of the financing of long term care is to be added to the two reform packages; this should be examined by the Swiss parliament by December 2004.
|Medienpräsenz||sehr gering||sehr hoch|
The impact of unbundling on the organization of the procedure of the Swiss health system will have to be evaluated in the light of its ability to encourage the reaching of a consensus between the parties on the more important and critical aspects of the reform.
The Federal Council's decision not to abandon the course of reforms undertaken in the recent past, but to organize the decisional process in a different way, that is giving up the idea of a unitary draft bill in favor of 6 separate messages, has to be interpreted on the background of the reasons which determined the rejection of the second revision of the Health Insurance Act (see Origins of Health Policy Idea) keeping in mind the impelling necessity to prolong some transitory measures (inserted into the Health Insurance Act or decreed by means of urgent federal laws) whose legal base expires in 2004 or 2005.
|Implemented in this survey?|
The decision not to abandon the reform path followed in previous years but to break the reform health insurance down into small packages, to be approved or rejected separately, is linked to the
reasons which led to the failure of the second revision of the Health Insurance Act in December 2003.
There are two possible keys to understanding that lack of approval:
The approach of the idea is described as:
renewed: Second revision of the Health Insurance Act, 2000-2003
The decision of the Federal Council to carry out the unbundling of the reform project of the Health Insurance Act is greeted in a positive way by all the stakeholders, especially by sickness insurers. The Cantons expressed some reserve concerning the accelerated procedure of consultation (through the Swiss Conference of Cantonal Directors of Public Health); they saw the risk of putting before parliament draft bills which, due to lack of the time necessary for proper coordination, do not enjoy the necessary political support.
In particular the process of consultation involves: the cantonal authorities (cantonal executives) and the various cantonal conferences (of the cantonal directors of finance, of the cantonal directors of public health etc.), the federal tribunals, the sickness funds (Santesuisse), the associations of the suppliers of services (doctors, physiotherapists, nurses), the associations of patients and consumers, political parties.
The consequences which are expected from this unbundling strategy are:
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
It is not so much the policy of unbundling in itself as the content of the single proposals which has an impact on quality, equity and effectiveness. For an assessment of the impact expected from the single measures we refer to the surveys 2004/2, 2004/3 e 2004/4.
About the rejected second revision of the Health Insurance Act:
The Federal Assembly - The Swiss Parliament, Krankenversicherungsgesetz. Teilrevision (00.079). Amtliches Bulletin 2001-2003, www.parlament.ch/ab/frameset/d/index.htm
"KVG-Revision hätte verschiedene Neuerungen gebracht", NZZ Online (17.12.03, 16:24), www.nzz.ch/2003/12/17/il/page-newzzDOBG5HF2-12.html
"Enttäuschung auf der einen, Freude auf der anderen Seite. Reaktion auf Scheitern von KVG-Revision", NZZ Online (17.12.2003, 16:20) www.nzz.ch/2003/12/17/il/page-newzzDOBJ35EK-12.html
Waber, B. (2003),"Kleine Schritte statt umfassende Operationen. Nach dem endgültigen Scheitern der KVG-Revision", Neue Zürcher Zeitung Nr. 294 (18.12.2003), p.13. www.nzz.ch/dossiers/2003/gesundheitswesen/2003.12.18-il-article9ATPU.html
About the new attempt to reform the Health Insurance Act:
Federal Department of Home Affairs (2004), Teilrevision der Krankenversicherung - in die Vernehmlassung gegebene Projekte.
Federal Department of Home Affairs (2004), "Krankenversicherung: Bundesrat stellt Reformplanung vor", Press Release of 2-25-2004
Federal Department of Home Affairs (2004), "Krankenversicherung: Bundesrat verabschiedet Vernehmlassungsvorlage", Press Release of 3-24-2004
Gerny D. (2004), "Vertragsfreiheit statt Ärztestopp. Couchepin will Selbstbehalt der Versicherten verdoppeln", Neue Zürcher Zeitung Nr. 47 (26.02.2004), p.13.
Schoch, C. (2004), "Happiges in homöopathischen Dosen", Neue Zürcher Zeitung Nr. 47 (26.02.2004), p.13. www.nzz.ch/dossiers/2003/gesundheitswesen/2004.02.26-il-kommentar9FKWF.html
Luca Crivelli (proof reading by Iva Bolgiani, Gianfranco Domenighetti, Massimo Filippini and Mary Ries)