HSK Forum 2023 – 1. Anmoderation und Referat Pierre Alain Schnegg

Very esteemed Mr. Chairman of the Board of the HSK Alex Friedrich, very esteemed members of the Board, very esteemed CEO of the ASK Ms. Kreutzer, very esteemed ladies and gentlemen. Thank you very much for the invitation to this conference. I am especially pleased to welcome you today in Bern. The Canton of Bern has set itself the goal of using the existing very good starting position as a medical location and taking a leading role. In Bern we have the renowned University Hospital Insel, the well-distributed regional hospitals, private hospitals and clinics, a large number of companies in medical technology and pharmaceuticals, research... Ladies and gentlemen, allow me to address a topic that greatly concerns me right at the beginning: health insurance premiums will rise again. You have heard it, the topic has already been placed in the media so that on the official day when premiums are announced, a national storm does not break out. But this storm has been brewing for decades. Ladies and gentlemen, we have been trying for a long time to curb the steady increase in healthcare costs, yet we are constantly overtaken by reality. The discussion about the future of healthcare has now reached a new urgency. You know, ladies and gentlemen, the cantons try to mitigate realities with premium reductions for families and low-income individuals. Even with the federal cost-containment measures, we have achieved almost nothing except an increase in administrative tasks. We work with band-aid solutions, but we need lasting improvements throughout the system. Why is our healthcare system so complex and confusing? I must formulate several statements. First, regarding the inpatient tariff system: many actors are involved—hospitals, insurers, and they are overseen by federal and cantonal authorities, plus associations and strong lobbies. The different tariff and fee structures hinder a clear cost overview. My firm opinion is that the energy of those involved should not be used to defend old positions but to shape the entire system together. Second, we have too much bureaucracy, regulation, and rules that no longer align with today's society, digitalization, and new professions. All this leads to available resources not being used optimally. And ladies and gentlemen, let's not dream—we will not have more skilled workers in the future; on the contrary, we will have to achieve more with fewer skilled workers. Third, there are still insufficient incentives for cost control. We must motivate hospitals to optimize treatment costs and use existing resources more efficiently. The system is still too vulnerable to volume expansion. Technical developments in medical and nursing care are enormous. Inpatient capacity must be adjusted, and outpatient capacity must be expanded. And yes, providers must rethink, but this requires new tariff structures and reasonable tariffs. This leads me directly to the challenges in the outpatient system. We have an imbalance in tariffs; some services are paid excessively while others are undervalued. We must prevent misincentives. There must not be volume-driven overprovision where medical services are provided not for the benefit of patients. We have too little oversight and must do more for targeted health prevention. The lack of care in peripheral areas is very high in many places. The family doctor is the linchpin and the hub for optimal health promotion and is, all things considered, the most cost-effective. Too many specialists, with a high number of specialists, the rising price spiral continues because everyone wants to earn, which is understandable but not always good for the system. The effects are then seen in higher health insurance premiums. We must instead promote family doctors and pediatricians and the health of the population. It is high time to give family doctors back their central place in our healthcare system. We must reduce administrative burdens on providers and use our energy to eliminate unnecessary administrative tasks. Too much bureaucracy leads to high time loss, and time loss affects patient care and generates costs, but also harms the attractiveness of the profession. Everyone can bring quick improvements on this point. The existing tariff system is too inflexible when it comes to adjusting prices and services. We need to develop a system that allows us to react quickly to new possibilities in medicine and healthcare. We don't want to pay for services that are well reimbursed but not state-of-the-art, just because new or more efficient methods don't yet have the right price tag. Ladies and gentlemen, I have listed the most important points we need to tackle if we want to keep the Swiss healthcare system under control. I have also shared my thoughts that digitalization plays a large—even decisive—role in all these measures. I also see enormous potential in the electronic patient record (EPD) if politics finally decides to make the EPD a usable and useful tool for everyone. Unfortunately, that is still far from the case. On the supply side, I also see possibilities: the service catalogs should be streamlined, and the excessive recognition of services co-financed by health insurance should be reduced. The catalog is currently very extensive. We should focus on basic care for the entire population that is at a good level and affordable for everyone, and not lead to second-class care. Anyone wanting luxury care should have to pay for it themselves and not be able to charge it through the general cost distribution. For years we have observed that due to high premiums, a sense of entitlement is generated in the population: 'If I pay such high premiums, then I also want a service in return.' This behavior leads to doctors' offices and emergency departments being increasingly occupied with trivial cases, and the price spiral continues, and the workload of professionals increases, which in turn worsens the image of the profession and increases the shortage of skilled workers. Ladies and gentlemen, we have reached a point where we must readjust the entire system. The Federal Council, the cantons, the insurers, and the providers are called upon. It is about the quality of our healthcare system. The Swiss healthcare system is a market that is too heavily regulated. A market normally lives from supply and demand, but in the healthcare market many framework conditions must be considered, making it difficult to react quickly to market changes, and adjusting laws takes even more time. Part of the population will soon no longer be able to afford the high health insurance premiums. But what escape routes are there? Ladies and gentlemen, look at some neighboring countries and you can observe the consequences of a state-run healthcare system 1:1. That is not a solution for Switzerland. What remains is help for self-help. The system partners still have a window of time to make the necessary adjustments themselves. We must offer solutions before the state compels us. Only then will we sit at the steering wheel and actively help shape the future. I am convinced that together and through dialogue we will find solutions for the future. In the meantime, all stakeholders have realized that the system will collapse if it is not renewed. Now, if everyone is willing to move away from a rigid position—for example in negotiations—we will find solutions. That does not mean that each party can expect the same share (33.3 percent), but that it is beneficial for all to be on the winning side and not among the losers. Where can we start? Let's talk about tariffs. Tariffs are either agreed in contracts between insurers and providers or set by the competent authorities. The canton intervenes when the contracting parties cannot find each other. It is not very sensible to let contract negotiations fail just so the canton has to decide. That hinders trust-building between partners. But this trust is very important when undertaking fundamental changes, and these changes throughout the entire healthcare system are necessary, as I explained earlier. The second starting point is the tariff systems. The tariff systems include different tariff structures for different service areas, for example TARDOC for outpatient tariffs and SwissDRG for inpatient tariff structures. I chair the Board of the new organization for outpatient physician tariffs, and therefore I am close to these topics. In the OAT, we have built a constructive dialogue. In the joint agreement of the tariff partners, it was agreed that the two tariff projects TARDOC and ambulatory flat rates (ambulante Pauschalen) would be further developed in the respective development companies until submission to the Federal Council, with mutual veto rights for finalization. That was the starting point for the journey together. In August 2022, the working group on tariff principles began its work. By the end of May 2023, it developed common tariff principles for outpatient physician services, which govern the interaction of individual service tariffs and ambulatory flat rates. After several rounds of adjustment in the working group and in the Board of Directors, the remaining differences were resolved on June 1, 2023, and the tariff principles were adopted unanimously. These principles also form the basis for the future work of the outpatient tariff organization and for the further development, adjustment, and maintenance of tariff structures for physician services. Our next major challenge will be to bring the two tariff projects—the individual service tariff TARDOC and the ambulatory flat rates—to the finish line. By the end of the year, they are to be submitted to the Federal Council for approval. The participating bodies and associations must also approve beforehand. The goal of all tariff partners is for the new tariffs to apply from January 1, 2025. All partners must understand that it is of great importance to be able to use these new structures soon, even if they do not initially meet all criteria and requirements of one side or the other. The two tariff works will in future be jointly coordinated, maintained, and further developed by the partner organizations within the OAT-AG. The two organizations ATS TMS and SDS SA will be dissolved. So we will have many opportunities for constructive dialogue on the new tariffs in the future. Collaboration and exchange is also the motto for the Swiss DRG system. In April, we expanded the organization and added Cura Futura and the Medical Tariff Commission UVG to the sponsorship. Now all tariff partners are at one table. Swiss DRG is a joint institution of providers, insurers, and cantons in the Swiss healthcare system. It is responsible for the introduction, development, and maintenance of inpatient tariff structures. With this integration, we have equipped ourselves for the future and are now organized in the same way as the OAT. Ladies and gentlemen, I am convinced that Switzerland continues to have one of the best healthcare systems in the world and will have it. Together we will work on it and address the challenges. I wish you a successful conference.