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The prospects for a rapid solution to the problem of the suspension of universal coverage for citizens who do not regularly pay their premiums ? highlighted two years ago ? were definitely too optimistic. The bargaining between cantons and insurers did not achieve a positive outcome, making a formal change of legislation through the Parliament necessary. In 2011 Switzerland will be back to universal coverage, but the door for the exclusion of unwilling-to-pay citizens will remain open.
The next few years will be bitter for Swiss insured. In 2010, health insurance premiums will rise by 8.7 percent on average and the increase will not stop there in the years to follow. The federal government presented a plan of urgent measures to contain the future increase of the premiums. The bill was watered down and then even annihilated by Parliament, exposing the present incapacity of the Swiss political system to find a consensus to solve the problem of the explosion of health care costs.
The moratorium on the opening of new medical surgeries will expire at the end of 2009. After renewing it twice, Parliament has decided to procrastinate by yet a further two years, while introducing some substantial changes. The new decree will expire at the end of 2011 in the expectation that consensus will be reached for a new alternative model which will regulate the ambulatory sector on a permanent basis.
On December 21st 2007, the Swiss Federal Parliament passed the new financing of hospital care through a DRG-based performance payment system (SwissDRG). The new financing method is due to come into force on January 1st 2012 and hospitals are now facing the challenge of adapting their cost accounting systems to support both the tariff negotiation process with health insurers and the internal strategic management process, thus providing useful and detailed information to hospital managers.
In June 2008, Swiss Parliament decided to prolong the moratorium on the opening of new medical surgeries for a second time; it was first introduced for a period of three years in July 2002 and extended for a further three years in 2005. The new decree will expire at the end of 2009. At this point a lasting solution must be reached. At least two alternative models appear on the horizon; a strenuous battle in Parliament is to be expected.
On 1 June 2008, with a clear majority, the Swiss people rejected a counter-project which was drawn up by Parliament as an alternative to the Swiss People?s Party initiative ?Yes to a reduction in compulsory health insurance premiums?. The aim of the counter-project was to include some principles in the Federal Constitution which the Swiss health insurance system is based on today, but also to make a break with the past.
After a tormented parliamentary procedure lasting several years the hospital financing reform bill was approved in December 2007. This time the losers were the cantons. The legislative process was longer than expected, not least because of their opposition to the dual-fixed model proposed by the Federal Council. Ex-post the cantons? strategy was a failure; the final text of the bill entails higher financial burdens and less autonomy for them than foreseen in the government?s proposal.
In June 2007 the Federal Office for Public Health outlined a national e-health strategy for Switzerland at the request of the Federal Council. Following the presentation of this document an ?e-health? office for coordination between the Confederation and the cantons was created. In 2009 the electronic card will be introduced for the insured. After a trial phase, characterized by the realization of regional IT platforms, finally the e-health strategy will be implemented at national level.
In order to promote the diffusion of insurance contracts with managed care characteristics among Swiss citizens the Federal Council suggests that Parliament defines networks of integrated care (with budgetary responsibility) as part of the federal law on social health insurance. At this stage Parliament is still searching for an appropriate solution.
From 1st January 2008 Switzerland has adopted a new system for financial equalization between the Confederation and the Cantons, which provides for a clearer attribution of the tasks and the financial resources associated with each governmental level activity. The financing of health insurance subsidies is one of the fields touched on by the reform. Although it remains a joint task of federal and cantonal governments, the sector is subject to deregulation with possible repercussions on equity.