EFAS: better quality of care and cost savings?

11. Oktober 2024 | Aktuell Allgemein

EFAS reform (uniform financing of services): This is intended to ensure that all services provided under mandatory healthcare insurance are financed according to the same distribution key, regardless of whether they are provided on an outpatient or inpatient basis.

With the reform of the EFAS (uniform financing of services), all services provided by mandatory health insurance are to be financed according to the same distribution key. Regardless of whether they are provided on an outpatient, inpatient or nursing home basis. The corresponding KVG amendment was adopted on 22 December 2023. The VPOD, however, launched a referendum against it. The referendum will take place on 24 November 2024.

Two innovations were introduced when the KVG came into force in 1996: on the one hand, compulsory insurance and the obligation of health insurance funds to accept all applicants in order to mitigate the problem of risk selection. On the other hand, solidarity between the healthy and the sick was strengthened. Within a health insurance fund, the amount of the premiums no longer depends on age, but is the same for all insured persons in a canton aged 26 or over. The principle of per capita premiums was thus retained, but solidarity within a health insurance fund was expanded.

The situation is serious

Meanwhile, the healthcare system in Switzerland costs 90 billion francs. The situation is serious because average premiums for compulsory health insurance have doubled in the last twenty years. According to a study by Avenir Suisse, 36 % of all health costs in the basic insurance are borne by the insurers, 23 % by the state, 22 % are self-payments and the rest is paid by private insurance companies. Around CHF 20 billion, and thus the most, is paid for inpatient treatment. The state contributes almost CHF 10 billion to these costs.

What do the proponents say?

The federal government and parliament recommend accepting the KVG amendment for the standardised financing of services. The cross-party Yes Committee, consisting of the GLP, SVP, Greens, SP, Die Mitte, FDP, as well as associations, pharmaceutical specialists, medical associations, doctors and hospitals, is of the opinion that accepting the proposal will reduce costs and relieve the burden on those paying premiums. Without reform, the problems of too many inpatient treatments, too little coordination among the players and excessive costs would come to a head.

What do the opponents fear?

On the other hand, parts of the left want to stop the health reform with the referendum. The Swiss Association of Public Service Employees (VPOD) had launched the referendum against the changes to the Health Insurance Act (KVG). It is supported by the Swiss Federation of Trade Unions (SGB), the Unia trade union and representatives of the SP and the Greens. Their argument: the changes to the KVG would result in a deterioration for the population, since, among other things, the inclusion of long-term care would lead to a further increase in premiums.

One of the most important healthcare reforms

In his podcast on 4 October 2024, Andri Silberschmidt, a member of the National Council for the FDP Zurich and the Committee for Social Security and Health, called the EFAS vote one of the most important healthcare reforms in a very long time. Without it, a standstill is inevitable and premiums will continue to rise. If the EFAS reform is approved, the burden on premium payers would be reduced by two billion francs annually. The fact that there are too many false incentives in the healthcare system means that cantons tend to be more interested in treatments being carried out on an outpatient basis so that they do not have to share in the costs. It is precisely this that could be remedied after 14 years of discussion in parliament with the adoption of the EFAS bill.

Geneva plans a single health insurer

The idea of introducing a single health insurer is anything but new. The Swiss electorate has already rejected a bill on a state-owned single health insurer four times, most recently in 2014 with 61.5 % voting no. The voters have thus repeatedly spoken out clearly in favour of competition and freedom of choice in the jointly financed basic insurance. In a representative survey conducted by the comparison service Comparis in April this year, 71 % were in favour of a single health insurance provider for basic insurance. Comparis therefore suggested testing the ‘single health insurance fund’ project in a model canton before the next vote. This would have allowed the population to know the advantages and disadvantages of competition between health insurance funds compared to a single health insurance fund before the next vote on a single health insurance fund.

Geneva as a pioneer?

It is not the first time that the canton of Geneva has played a pioneering role with regard to the canton’s public health insurance fund. It is no wonder that the highest health insurance premiums in Switzerland are paid in Geneva. After 2015, the initiative of the Council of States was again examined by the Health Committee of the Council of States on 7-8 October, according to the meeting schedule. And unlike before, some conservative politicians are even willing to talk about the topic.

As a test, Geneva would be a good idea for a period of five years, as Comparis expert Felix Schneuwly has already said several times and most recently to the NZZ.