Purpose of health policy or idea
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.
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.
Political and economic background
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
|Implemented in this survey?
Origins of health policy idea
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.
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.
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
- 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
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.
- 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.
Empfohlene Zitierweise für diesen Online-Artikel:
. "Hospital Funding Competences Revision". Health Policy Monitor
, 20030506. Available at http://www.hpm.org/survey/ch/b1/4