Hospital Funding Competences Revision

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Purpose of health policy or idea

• Content
  A new interpretation of Art. 49 of the Law of Health Insurance (KVG) led to a re-arrangement of the funding responsibilities for inpatient services within the compulsory insurance between the cantons and the health insurance funds.

 

• Goal
  Correction of an inconsistency within the KVG: Elimination of the discrimination of the insured with supplementary (private) coverage suffered due to the public financing of inpatient services within the system of the so called "dual hospital funding" (cantons and insurance funds share the costs of inpatient services in public hospitals). The former interpretation of the law (article of the dual hospital funding/financing) led to cross-subsidization from the insured who have supplementary coverage to the insured with only compulsory insurance coverage.

 

• affected group:
  1) the insured with supplementary coverage: they now also are eligible for public subsidies in the context of the compulsory health insurance coverage, when they stay in a public hospital (this "public basic contribution" is at least 50% of the operating costs of a common ward in a public hospital (services within the definition of the compulsory coverage). This implies a positive effect for this group.
  2) cantons: Under this new definition they have to contribute subisidies also to the insured with supplementary coverage (see above "public basic contribution"). This means an expansion of publicly provided funds within the health care sector. This has a negative effect for the cantons because it means enlarged financial duties and higher public expenditures.
  3) insurance funds: Their overall financial contribution to the inpatient sector will be lower, which is a positive effect for them.
• incentives
  financial

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

see below

Complies with

Amendment of the KVG: Establishing compatibility among the special elements of the Law of Health Insurance, especially to ensure equalization between the different segments of the insured (compulsory and supplementary) concerning public subsidies for inpa

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

Origin:
The new interpretation of art. 49 KVG and thus the cantonal duty to subsidise inpatient services also for the insured with supplementary coverage was raised by the federal court for insurance law (Eidgenössische Versicherungsgericht EVG: court decision of 30th November 2001). This decision was the reply of the complaint of an health insurance fund (Assura) raised against a canton (Geneva). The canton had refused to pay the amount of the public subsidy for a patient with supplementary coverage in a privat ward of the cantonal hospital.

Stakeholder positions

driving force/cause:
private health insurance fund Assura (its complaint) resp. court-decision of EVG.



positions of stakeholder towards the new interpretation of the law:

•  

 

• the health insurance funds, represented by the national association santésuisse (Schweizerischer Verband der Krankenversicherer) welcomed  the court decision. They would have to pay less for hospital services in the future.
• the cantons (cantonal departments of health/Sanitätdirektionen), represented by the umbrella organisation SDK (Schweizerische Sanitätsdirektorenkonferenz SDK) disliked the court-decision because they have to provide additional funds to the hospital sector.

Influences in policy making and legislation

• result legislation:
  governmental resolution: "law for a better funding of hospital services."

Adoption and implementation

• involved stakeholders in the workout/implementation process:
  1. cantons: cantonal departments of health, also their  umbrella organisation SDK and the cantonal departments of finance.
  2. insurance funds, represented by their association santésuisse

 

• result of workout process:
  the negotiation between the cantons and the insurance funds about their responsibilities how much to subsidise resp. to pay led to a "compromise". The fraction (subsidies) which the cantons have to pay for the insured with supplementary coverage will only gradually (and not at once) raised to the full amount until 2004. This means that the cantons have to pay 1,2 billion Swiss Francs until 2004. This is 350 million Swiss Francs less than it would have been when the court decision would have become immediately effective.

 

• opposition:
  the insurance funds Assura and Supra opposed this solution. In October 2002, Assura handed in the referendum. They claim higher public contribution. They want the court-decision to become effective immediately.

 

• political result/final result:
  On the 9th of February, 2002, the referendum was dismissed by the voters. The solution of the negotiations (governmental resolution) will become effective.

Monitoring and evaluation

evaluation:
none

Expected outcome

achievement of (legislative) goal:
the equalization of the different groups of insured (compulsory and supplementary) will be achieved within the context of the dual funding of inpatient services. The former cross-subsidisation of the insured with supplementary health insurance coverage to the compulsory insured will be eliminated gradually.



problems:
- the problems of lacking cost transparency, trueness and control within a system of dual funding remain.
- The expanded subsidisation will lead to a cost resp. price bias between public and privat hospitals also in the supplementary inpatient sector (the subsidies imply a price advantage for the public hospitals in comparison to the private hospital towards the insurance funds).
- The overall expansion of the subsidisation for the insured with supplementary coverage contradicts the principle of a differentiated social distribution mechanism.
- further public regulation will be automatically enforced due to the interdependancy of the different articles of the KVG: e.g., the contents of the cantonal planning of inpatient capacities depends on the defintion of the funding of the inpatient services. Inpatient services for insured with supplementary coverage will now also be subject of the hospital planning.

References

Empfohlene Zitierweise für diesen Online-Artikel:

. "Hospital Funding Competences Revision". Health Policy Monitor, 20030506. Available at http://www.hpm.org/survey/ch/b1/4