Vote on November 24, 2024 The most important facts about the Efas health reform

On November 24, Switzerland will vote on the uniform financing of outpatient and inpatient healthcare services. An overview.

Should outpatient and inpatient healthcare services be financed uniformly? The Swiss electorate will decide on this on November 24. The VPOD trade union is fighting this paradigm shift in the healthcare system with a referendum. The most important facts about the proposal:

Healthcare services covered by basic insurance are currently financed differently depending on where they are provided. Inpatient services - i.e. when the patient stays overnight in hospital - are paid for 55% by the cantons. The health insurance fund pays 45 percent. Outpatient treatment - when patients go home on the same day as the procedure - is covered by the health insurance alone. In long-term care - for example in a nursing home - patients and health insurance companies each pay a fixed contribution towards the cost of care. Depending on the canton, the remainder is borne by the cantons and/or the municipality of residence.

Medical advances mean that more outpatient treatment is possible. Overall healthcare costs will also rise, to CHF 91.5 billion in 2022. Health insurance premiums will also increase from year to year.

The Efas bill ("Uniform outpatient and inpatient financing") adopted by Parliament in December 2023 will see all healthcare services financed from a single source. The cantons should always pay at least 26.9% of the costs (after deduction of the patient's deductible and co-payment) and the health insurance funds should pay a maximum of 73.1% via the premiums. The cost sharing is based on the average of the reference years 2016 to 2019. The uniform financing of outpatient and inpatient treatment is to be implemented from 2028.

In long-term care, the system change will take place in 2032. One prerequisite for Efas in long-term care is uniform tariffs, which must first be negotiated.

Because they co-finance all services, the cantons are given additional control options. They have a say in the tariff organizations. They can now not only draw up hospital lists and control the admission of doctors, but also that of other outpatient service providers.

Proponents expect the bill to remove false incentives, namely because there will be fewer hospital stays and later admissions to nursing homes. From the point of view of health insurance companies, hospital stays are currently attractive because the cantons also pay for inpatient treatment. In addition, the coordination of care is improving, especially for the chronically ill. According to a study commissioned by the federal government, this could save up to 440 million francs a year in the best-case scenario. The fact that more treatments will be carried out on an outpatient basis will reduce premiums by around two billion francs in the year of introduction.

The cantons wanted long-term care to be included in the proposal. According to the Conference of Cantonal Governments, this means that the health insurance funds will help to cover the cost development in nursing homes. However, this would not place a greater burden on premium payers, as the cantons, for their part, would contribute to cost growth in the outpatient sector and for medication.

The VPOD trade union has launched a referendum against Efas; the Federation of Trade Unions and the Unia trade union are now campaigning for a "no" vote. In their words, the reform pushed through by the health insurers and the conservatives in parliament is harmful. The change of system would mean worse conditions for nursing staff and patients because power would shift to the health insurance funds. It is not the health insurance funds, but the public sector that should control healthcare.

Opponents also fear that premiums will continue to rise, particularly due to the inclusion of long-term care. This is because expenditure in this area is rising particularly sharply due to the ageing population. Opponents also fear that the cantons would relinquish responsibility for care in nursing homes or through Spitex. If the cantons were to withdraw from the financing and organizational responsibility for nursing homes and Spitex, the "red carpet" would be rolled out for private, profit-oriented players.

The Federal Council and Parliament support the bill. All parliamentary groups voted in favor by a majority. Members of the SVP, SP and Greens voted against.