Swiss lawmakers back CHF50 fee for emergency hospital visits

Adults seeking treatment at Swiss hospitals’ accident and emergency (A&E) departments without a doctor’s referral note should pay a fee of CHF50 ($63), say lawmakers in the House of Representatives. The goal is to curb rising healthcare costs.

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On Wednesday they adopted a related proposal by 96 votes to 91, with 3 abstentions.

The project aims to relieve the pressure on hospital emergency admissions and curb rising costs in the healthcare system, the parliamentary initiative says.

Exceptions are made for certain groups of people. These include children, pregnant women or people who have been referred to a hospital in writing by a doctor, pharmacist or telemedicine centre. People who have been referred to a hospital by an outpatient clinic would also be exempt.

The fee is aimed at adults who go to hospital A&E departments on their own unannounced, said Patrick Hässig of the Liberal Green Party, who presented the proposal.

The Swiss People’s Party, the Radical-Liberals and the Liberal Greens all supported the proposal. The Social Democrats, the Centre Party and the Greens opposed it. The Federal Council also rejected it. Several minority motions were rejected during the debate. The majority proposal of the preliminary consultation committee prevailed.

Creation of a ‘bureaucratic monster’

In his speech on behalf of the parliamentary group, Lorenz Hess of the Centre Party underlined the negative reactions during the consultation process. These had shown that the proposal would not work, he said. Manuela Weichelt of the Green Party said the fee would not solve problems, but rather create new ones.

In all, 87% of people who took part in the consultation process rejected the fee and 21 cantons out of 26 also turned it down.

Sarah Wyss, a Social Democrat from Basel, described the fee as an “absolute bureaucratic monster” and a “special regulation” for Zurich.

“Personal responsibility is strengthened”

“Zurich wants this,” said Martin Bäumle of the Liberal Greens. The bill is a small step towards getting healthcare costs under control. In addition, the introduction of the fee is voluntary for the cantons.

The regions that wish to do so should be given the opportunity to levy the surcharge, said Kris Vietze of the Radical-Liberal Party. She also spoke of an “incentive tax”. Andreas Glarner, a People’s Party lawmaker from Aargau, also sees the proposal as a way of controlling costs and strengthening personal responsibility.

Health Minister sees six disadvantages

The Federal Council rejects the proposal for six reasons, according to Health Minister Elisabeth Baume-Schneider. The expected impact would be minimal. Many patients would not be affected by the regulation, as only people who reached the deductible would have to pay the fee.

She also believes that additional costs could arise. These would be incurred if a prior medical examination were required for emergency authorisation.

The implementation of the proposal is also questionable. For example, telemedicine centres are currently unable to issue written referrals. And as the proposal gives the cantons the option of introducing a fee, the solution would not be standardised throughout Switzerland.

The issue will now be discussed in the Senate.

Debate started in 2017

The debate was triggered in 2017 by a parliamentary initiative from former parliamentarian Thomas Weibel of the Liberal Greens. He called for a fee on minor cases in hospital emergency admissions.

During preparations for the House of Representatives debate, a proposed fee for minor cases was dropped because lawmakers could not agree on how to define a “minor case”.

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Adapted from German by AI/sb