At this year’s Lucerne “Trend Days Health”, Prof. Dr. Stefan Felder, Basel, raised the question of whether it really makes sense to regard market control as one of the most important factors in healthcare. Above all, he pointed to the manifold tensions arising from the unfortunate combination of free-market and planned economy considerations.
It is questionable whether the state even knows the supply that is needed and, whether it can estimate what supply the market would produce. Therefore, government regulations must always be critically scrutinized and must be examined for the time being. The fact is that the hospitals here are expensive. In 2008, they generated significantly more costs in terms of GDP than their foreign counterparts, for example in France, Germany, the USA or Sweden (table 1). The flat rates per case also show high values. Compared to Germany, people in Switzerland paid well over twice as much for stomach surgery or heart valve surgery in 2010.
The basic ideas for the new hospital financing are therefore financing via flat rates per case, subject instead of object financing, but above all strengthening competition. In the future, insured persons will have greater freedom of choice and there will be more transparency with regard to efficiency and quality. Last but not least, it seems reasonable to put public and private hospitals on an equal footing.
Structural adjustments, such as optimizing treatment processes, increasing efficiency and reducing overcapacity, would also have to take place, according to Prof. Dr. Sefan Felder, Professor of Health Economics at the University of Basel.
Regulation vs. competition
The question remains whether the new hospital financing can be better organized via prices (market economy) or via volumes (planned economy). Prof. Felder emphasized that tensions arise from these two poles: The revision of the Health Insurance Act (KVG revision), for example, introduced Diagnosis-Related Groups (DRGs), which means that prices are the starting point. At the same time, it requires the cantons to plan hospitals to prevent underuse. This planning mandate not only runs counter to the market-based steering effect of DRGs, but also leaves some room for interpretation, which is interpreted differently by the cantons. In addition to additional criteria for listed hospitals, the partly arbitrary awarding of service contracts, quantity limits or the restriction of the share of supplementary insureds, open and hidden subsidies as well as support funds for public hospitals fall into this area. Overall, this restricts competition.
More competition instead of a planned economy
According to Prof. Felder, however, the solution lies precisely in increased competition, not only in the hospital sector, but also with regard to the licensing of physicians. In principle, no restrictions on freedom of contract, purpose of acquisition, or antitrust laws should apply in any area. Financing should come from a single source, and the multiple roles of the cantons should be clarified and unbundled, Prof. Felder concluded.
Source: “Market control as the most important factor in health care?” 9th Trend Days Health Lucerne, February 27-28, 2013.
