Implementation of uniform financing

The standardised financing of benefits was approved by 53.3% of the Swiss electorate on 24 November 2024. CSS supports this important reform, which will boost the shift towards outpatient care, give fresh impetus to integrated care and have a positive effect on healthcare costs and premiums. The amendment comes into force for acute services on 1 January 2028 and for nursing and care services on 1 January 2032.

The uniform financing of healthcare benefits means that, in future, health insurers will pay 100% of the costs in all service areas while the cantons will fund a share of the total costs in their canton (currently at least 26.9% of the total costs). These funds will find their way back into the system, thus benefiting the premium payers.

The next few years will decide whether the full potential of uniform financing can be unlocked. All the actors in the healthcare system are now called upon to play their part in ensuring that implementation succeeds. The following areas take priority:

Promoting outpatient services

Outpatient treatment is generally cheaper than inpatient treatment and often makes more sense medically. However, at present the costs are completely covered by the premiums. As a result, the bill for shifting from inpatient to outpatient care, as championed by the policymakers, is borne solely by the premium payers. Uniform financing eliminates this false incentive and paves the way for accelerating the shift towards outpatient settings. Measures such as the cantons setting targets for outpatient care in their hospital plans and health insurance providers targeting their insured persons with information about the (cost) advantages of outpatient treatment could support this. In addition to having a positive effect on costs, greater outpatient delivery will also bring qualitative benefits for patients, as outpatient procedures tend to be less stressful.

Strengthening integrated care

Duplication and unnecessary treatment can be avoided through properly coordinated care, especially for the chronically ill, which then has a positive effect on quality and costs. However, until now, the different financing arrangements have restricted the potential of integrated care: Coordination costs are primarily incurred in an outpatient setting, which is funded through premiums, while savings are mostly made in inpatient care (e.g. by avoiding hospitalisation). Uniform financing will enable such savings to be passed on to the insured persons more directly in future (e.g. in the form of higher discounts on alternative insurance models), thus making coordinated care more attractive to everyone.

Lean implementation of invoice double-checking

The legislators have decided that insurers and cantonal authorities should continue to double-check bills for inpatient care. In implementing the reform, it will be important to ensure that these cantonal checks are kept as lean and unbureaucratic as possible.

Cost transparency in relation to long-term care

With regard to long-term care, the tariff partners have been asked to create conditions that will enable the standardised system of financing to be implemented from 2032. Their main task is to develop new tariffs for nursing care using a transparent data and cost basis.