Hospital planning: Council of States deprives cantons of competencies

There are too many hospitals in Switzerland, most politicians agree. A concentration takes place, as Federal Councilor Elisabeth Baume Schneider said on Wednesday in the Council of States. «The number of beds drops. And there is a movement from small to larger structures. »

However, this policy of small steps is not enough for the Council of States: with an overwhelming majority and without counter -speech from the plenum, the cantonal representatives decided with 41 to 2 votes to attract the screw. Specifically, the cantons not only have to coordinate hospital planning, but also the service orders within pension regions. If you do not meet the order, the federal government should take over the planning.

In health policy, this decision means a small revolution. Because the constitution specifies: the health care is the responsibility of the cantons. And so far they have also defended this federalism at the national level. So the Thurgau health director Urs Martin was convinced at the beginning of the year, that national planning would « fail in the Council of States at the latest ».

Gärtli thinking leads to overcapacity

Now exactly this Council of States has decided to tighten. You don't have to search long for the reasons: the hospital costs make up around a third of the health costs of almost 100 billion francs annually. And given the high density of hospitals in certain areas, a better agreement makes sense.

SVP Councilor Esther Friedli (SG) represented the Commission: « Cantonal gardening thinking leads to harmful competition. » For example, offers would be expanded uncoordinated, which caused the hospitals to produce overcapacity, which in turn lead to unnecessary treatments and increasing health costs. « The cantons must now be bindingly obliged to plan nationally. »

In short: the thread of patience is torn. National politics no longer want to watch the cantons' lavier. The health director Lukas Engelberger recently explained that the health directors have no pleasure in this in an opinion contribution: It is neglected that the inpatient hospital costs have hardly grown in the end.

In addition, there are better starting points to keep the competition up but to avoid overcapacity, the President of the Cantonal Health Directors' Conference continues. He cites examples to limit the hospitals of the hospitals if they no longer receive a service mandate from the canton. Or the contractual hospitals who do not like the cantonal hospitalist to prohibit billing on mandatory health insurance.

The cantons still have one chance

The lobbying is too late – or not at all. The cantonal governments may also have been surprised by the initiative: the State Commission developed it in January, two months later it was through the first and crucial advice. It is rather unlikely that tightening will fail in the National Council.

The time pressure is wanted, as Friedli continues: « The regulation on intercantonal coordination of hospital planning adapted to the intercantonal coordination of hospital planning in 2022 has no effect. » The Council of States now wants to increase the pressure so that the cantons themselves get into the aisles.

Other, sharper pretense for national planning are still under discussion in parliament. Friedli says that the Commission still retains them because the cantons have time to coordinate hospital planning by the end of the year. The Council of States therefore holds the knife to the health directors. Until then, it is in the power of the cantons to keep sovereignty in hospital planning.

It is not only this new threatening setting that the wind has turned into the Council of States. A vote by the Graubünden FDP Council of FDP Martin Schmid to cooperate in the cantons in specialized medicine also makes you take notice. « So far I have always resisted that you are doing national hospital planning. » He was admitted to the cantons. Now he is asking himself whether national planning would not be « more consistent and better ».