False incentives: why thousands in Switzerland are lying in an expensive hospital bed, although they would recover better at home.
Good health is quality of life, and that costs: in 2021 in Switzerland over 86 billion francs, as the latest shows Pay of the Federal Statistical Office. That is almost 6 percent more than in the previous year. This is also related to Corona, but because the population is getting older and medicine can do more and more, it will probably continue to be more expensive in the future.
In one area, medical progress not only leads to better quality, but also to major savings: Doctors can operate on more and more procedures without injuring a lot of tissue, and patients can thus recover at home instead of in an expensive hospital bed. This is already happening: as the latest figures show, around 32 percent of treatments in hospitals are carried out on an outpatient basis.
Outpatient procedures are hardly worthwhile for the hospitals
Outpatient operations are cheaper for the cantons, health insurance companies and the patients themselves. How much depends from surgery to surgery.
Although outpatient is cheaper, outpatient procedures are not financially attractive for hospitals. There are two reasons for this: First, cheaper for the general public means less revenue for the hospitals. And secondly, according to the hospital association H+, the tariffs in the outpatient area do not cover costs.
Why is there still more and more outpatient surgery?
Above all, investments cannot be covered with the outpatient tariffs, says Kristian Schneider, Vice President of the Hospital Association H+ and Hospital Director of Biel. And yet more and more outpatient surgeries are being performed.
He explains it like this: “First, we have to perform certain operations on an outpatient basis.” The Federal Office of Public Health has had one since the beginning of the year List introduced with 18 intervention groups, which are only reimbursed on an outpatient basis. This means that if the hospital still carries out inpatient treatment without good reason, it only receives the much lower outpatient tariff – a negative business.
Secondly, the new possibilities to carry out interventions on an outpatient basis are good, sensible medicine. “It’s rather dangerous to lie in a hospital bed.” Bacteria and viruses are centered in the hospital, and this increases the risk of infections and contagions. In addition, patients recovered faster at home, mainly because they moved more.
It’s rather dangerous to lie in a hospital bed.
Fear of bloody layoffs
But that doesn’t apply in every case, says Susanne Gedamke from the Foundation for Patient Protection: “If aftercare is not organized, then it can be just as dangerous at home.” You often hear about early layoffs. In principle, however, she also supports the trend towards more outpatient operations, and many patients also wish for this.
For the hospitals, outpatient treatment comes at exactly the right time, says Schneider. Outpatient surgeries need fewer resources: “And in the future we will need the specialists and the beds for the older, sicker patients.” It doesn’t work without it.
In the future we will need the specialists and the beds for the older, sicker patients.
In France, around 60 percent of new hips are fitted on an outpatient basis, in Switzerland just 1 percent. However, the goal is not to operate as much as possible on an outpatient basis, but where medically indicated. The hospital director and the patient advocate agree on this. But one thing is also clear: the potential is great.