1.4 million more billed Hundreds of senior citizens in Zurich are now suddenly considered care cases
An inconspicuous letter is causing massive anger in the city's retirement centers: around 400 residents are now considered to be in need of care - without any change in their health, simply because of a change in the system.
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- The city of Zurich has reclassified almost 400 senior citizens as being in need of care - because of a technical system change.
- This could result in an additional CHF 1.4 million a year being charged to health insurance companies.
- Insurers are fighting back: without a genuine need for care, no services should be billed.
What looked like a routine letter to those affected has far-reaching consequences: 21 municipal health centers informed their residents in the summer about the switch to the new national RAI classification system. But the changeover has an explosive side effect. The lowest level - "not in need of care" - no longer exists in the new system.
This means that 392 previously independent residents are automatically considered to be in need of care. Medically, nothing has changed for them - only the classification, as "K-Tipp " writes this week
The result: the city can charge the health insurance companies up to 1.4 million francs extra in future. There will be no additional costs for the homes. Only the financial flows will shift: less burden for the city budget, more bills for the insurance companies - and, from 2027, higher co-payments for those affected: CHF 7.60 per day.
According to "K-Tipp", several insurers have already announced their opposition. They see the changeover as a pure billing effect that contradicts the purpose of the new system.
Healthcare system in the canton of Zurich is being reformed
The Department of Health refers to the RAI system, which will soon apply nationwide. The reclassification is mandatory and there are no alternative solutions. In addition, an individual needs assessment was carried out for all cases.
The fact that the system change should have "no financial impact", as the national industry organization Artiset emphasizes, is not disputed by the city. It sees the adjustment as a correct implementation - even if the burden now falls largely on the health insurance companies.
The reclassifications come at a time when the canton of Zurich is restructuring its entire system. Back in April, it was announced that older people now have to change their place of residence when moving to a care home outside of Zurich - even if their partner still lives in the old municipality. At the time, several Zurich municipalities criticized the "bureaucratic, unrealistic" rule, which tears married couples apart administratively and confuses the distribution of costs between municipalities.
However, the tension between rising care costs and the burden on the health insurance funds is also nothing new. This summer, it became known that the salaries of top health insurers continue to rise year on year despite premium increases. At the same time, federal evaluations show that more than one million insured persons do not change health insurer for reasons of convenience or uncertainty - and therefore pay unnecessarily high premiums.
