The healthcare system in Switzerland is faced with some major challenges. No-one would argue that savings need to be made. But how and where? This blog explains why “outpatient over inpatient” plays such an important role in efforts to cut costs.
The Swiss healthcare system is a complex thing. And each and every year, the Swiss population is spending more and more money on healthcare. The Swiss Federal Statistical Office reports that in 2021 the total bill topped 86 billion francs, which equates to CHF 827 per person, per month – or almost CHF 10,000 a year. That’s a whole lot of money. But how can costs be lowered without compromising the quality of healthcare overall?
Technical advancements and minimally invasive surgical techniques mean that more and more operations can be performed as outpatient procedures. When a patient undergoes outpatient treatment, they leave the hospital on the same day of the procedure. This is medically preferable in many cases, because patients tend to heal faster in the comfort of their own home than they do in hospital. At the same time, foregoing inpatient treatment saves several thousands of francs. It was with this in mind that at the beginning of 2019 the federal government introduced a new regulation: “outpatient over inpatient (in German),” ("ambulant vor stationär" in German, abbreviated as AVS or AVOS). This regulation stipulates which operations must now be performed exclusively as outpatient procedures. Basic health insurance will only cover inpatient treatment for these operations in justified cases. The result: AVOS procedures have dropped in cost by about one third since 2019. What’s more, it’s become clear that many patients welcome the opportunity to go outpatient rather than inpatient.
However high the pressure to cut costs, this must never be at the cost of patient care. So what are the advantages of outpatient versus inpatient from the perspective of those affected – and vice-versa?
If outpatient treatment is indicated for medical reasons, it offers some notable advantages:
More involved and complicated operations bring with them risks that require a stay in the hospital. These are the most important reasons.
A common fear with outpatient care is that problems may arise after discharge. What if my wound starts bleeding? How will I manage on my own? It’s important to know that all procedures that fall under the “outpatient over inpatient” regulation are minimally invasive, meaning the risk of secondary bleeding and other complications is low. Patients are only discharged if they meet a specific set of criteria. The main scenario in which problems may arise later on is due to a lack of appropriate aftercare (Spitex, home care, SRC, Pro Senectute, family members, etc.). The takeaway here is that good preparation and organization are critical throughout the entire period of recovery.
In many cases it is medically advisable to perform operations as outpatient procedures – and is also the preferred choice for many patients. This approach also saves big on costs. So why is the proportion of inpatient treatments in Switzerland still so high compared with other countries? One of the main reasons is the way treatments are billed depending on whether they are performed outpatient or inpatient:
Problem 1: As outpatient procedures become more commonplace, this saves money overall, but the financial burden is shifted to the health insurer. This, in turn, can lead to higher premiums.
Problem 2: The TARMED pricing system is outdated. Under the system, hospitals don’t receive enough on some outpatient procedures to even cover their costs. This means hospitals make more revenue and more profit from inpatients than they do from outpatients. (Even though, on the flipside, this results in a lack of beds and staff.)
There needs to be a complete overhaul of the way hospital procedures are billed to resolve these contradictions and false incentives. Politicians have been debating this very topic for several years now with the EFAS (in German) project, which aims to standardize how outpatient and inpatient services are financed. Outpatient treatments will continue to increase regardless of how long these well-known problems remain unresolved – but not as fast as they could do or would be in the best interests of the healthcare system overall.