Too deep tariffs ensure millions of deficits

The concern is actually old and relatively banal: services in pediatric medicine should be remunerated. While this has been more or less successful in the inpatient area for a few years, the tariffs in the outpatient area have not corresponded to this claim for years. The six large children's hospitals in Switzerland lose massive money: in 2023 they drove a cumulative loss of around CHF 110 million.

The Allianz Children's Gospel Switzerland (Allkids) follows the development with great concern. In 2026 a new outpatient tariff system is introduced (Tardoc plus flat rates), but the association expects a further deterioration. The question arises how deep into the minus should the hospitals still fall?

The increasing deficits come with an announcement. For years, the responsible bodies have known that the tariffs are not sufficient for survival. When uniform DRG case flat rates were introduced with the new hospital financing in 2012, the children's hospitals finished financially for the first time. The new tariff system does not depict the peculiarities of pediatric and adolescent medicine.

After 10 years and 150 applications, the children's hospitals have obtained improvements, so that at least no more money lost in the inpatient area. However, due to the inflation and the interventions of the Federal Council on Tarmed 2014 and 2018, there were also deficits in the outpatient area. The cantons St.Gallen and Basel As early as 2017, requested fair tariffs for pediatric medicine in 2017.

The same tariff regardless of the effort

The growing underfunding can be explained with the extensive range of large children's hospitals and the fact that the outpatient share of total sales is above average. In addition, children's hospitals provide disproportionately number of patients with rare diseases (30 percent), and around a third of the patients also suffer from birth crimes, for example from innate malformations. Diagnostics and therapy for small children are particularly complex in these categories – and therefore deficient.

This illustrates the simple example of imaging: While the vast majority of adults are without problems lying in the tube to create an MRI, a child has to be sedated frequently – or it even needs anesthetic to be shut down for a few minutes. However, the tariff is the same for adults and children, regardless of the effort.

More time for everything – especially for the parents

The Association of Children's Hospitals has identified four main reasons for the growing deficit based on the data of the six large children's hospitals. First of all, the big losses apply to the treatment of rare diseases, secondly in emergencies and thirdly in outpatient interventions.

In principle, fourthly, a child needs more time: treatment must always be explained to the child and the (critical) parents. In addition, children need more persuasion to indicate and cooperate.

This time is also circumcised in the new TARDOC and also insufficiently taken into account in the outpatient flat rates. The new tariff would give the opportunity to improve the situation. At least the topic was addressed several times. In 2020 the parliament commissioned the Federal Council, the children's hospitals were to be costly covered with “efficient services”. And the Federal Council explained that there is no need to change the law. In return, however, he promised to “pay particular attention as part of his skills on the collective bargaining structure development of pediatric medicine”.

The good intention was until the dispute over the new outpatient medical tariff TARDOC went into the hot phase and was deplected: The elementary emergency surcharge for the children's hospitals was eliminated, a consultation was limited to 20 minutes (limitation) and with the simultaneous introduction of new outpatient flat rates, the financial situation around pediatric medicine is threatened Frenzel, Managing Director of Allkids.

Because the Federal Council ordered that the introduction of the new tariffs must not cause any additional costs. This means that the tariffs must not be increased over three years. The requirement could lead different hospitals into the misery.

Dull views for improvement

The Federal Council continues to explain that it « Great emphasis on the promotion of basic care, which also includes pediatrics ». But the tariffs, the insurers and hospitals are responsible for the tariffs. In reality, either a foundation or the canton of money, like the recently, shoots the canton of Zurich, which the children's hospital transferred another CHF 25 million at the beginning of the year.

Such financial injections are necessary for the children's hospitals. But they are a weak consolation, as Malte Frenzel says. «We do not want to depend on the cantons. The health insurance law requires cost -covering tariffs. We want a law -compliant tariff structure that we can work with. »

That is a future music. Because the prospects are much worse than in 2012, as Malte Frenzel says: «At that time we assumed that the new DRG tariff at least covers our costs. Today we start in the red on the basis of CHF 110 million. » The prospects are also grueling: only steps have obtained improvements since 2012. « We fear that we will experience the same thing again with the Tardoc and the outpatient flat rates. »

The Federal Council also has whether the old demand for fair compensation will be heard if it is approved by the new tariffs at the end of the month – or rejects it again due to the undifferentiated treatment of children and other defects.