Until 1998, the motto in the canton of Bern was: “Every valley has its own hospital.” Why there are now half as many hospitals as there were then.
The hospital landscape in the canton of Bern has changed significantly over the past 25 years. While there were 29 public hospitals in the 1990s, today there are only 13.
What happened? A search for clues in three parts.
1. The hospitals
Let’s start with the question: Why were there so many hospitals 25 years ago? The reason was the construction boom after the Second World War. Hospitals were seen as a sign of prosperity. But over time it became clear that there were not enough patients for so many hospitals. And the costs were rising.
Legend:
The hospital in Jegenstorf, which opened in 1891, was closed in 1999.
Keystone/Lukas Lehmann
The canton was responsible for hospital planning until 2007. Then the public hospitals were divided into seven regional groups that functioned as independent joint-stock companies. From then on, they were supposed to decide among themselves which hospital would provide which treatments.
But the new model did not create cooperation, but competition. That is why hospitals began to invest in new technology, renovations and new buildings. But further hospital closures could not be avoided.
2. The money
For a long time, money was not an issue for public hospitals: the canton covered deficits and investments. But then, in the 1990s, costs rose sharply because many hospitals needed renovation and wages had risen.
The canton tried to reduce costs by closing hospitals – without success. Annamaria Müller, a health care consultant, explains: “Saving in the health care system does not mean spending less, but rather slowing the rise in costs.”
Legend:
The Canton of Bern is providing 100 million francs in loans or guarantees for financially struggling hospitals.
Keystone/Marcel Bieri
In 2012, the principle of a flat-rate fee was introduced: the canton then paid a flat rate per treatment case. In return, it no longer covered deficits and investments. Not all hospitals were able to make this change; they had to reduce their services and close departments. Annamaria Müller, then head of the Bern Hospital Authority, felt the effects of this: “For a while, I was dragged through the newspapers as the murderer of rural hospitals, but in the end there wasn’t much I could do.”
Today, money is once again central: many hospitals are running at a deficit, not only in the canton of Bern. High energy prices, expensive medicines and treatments are causing problems for hospitals.
3. Politics
Closing hospitals to reduce costs is no longer an issue today. Bern’s Health Director Pierre Alain Schnegg (SVP) says: “Closures would lead to a supply problem.” But he demands that hospitals should bundle their services better and coordinate better.
Legend:
The Insel Group made a loss of 113 million francs in 2023.
Keystone/Anthony Anex
Another demand: more outpatient operations so that people can go home quickly. This is the only way to compensate for the shortage of skilled workers. In addition, hospitalization at home is being tested in Switzerland.
The question remains: which hospitals will survive?
“It all depends on the organization and the network,” says Health Director Pierre Alain Schnegg. For Annamaria Müller, a health care consultant, the crucial question is: which hospital is thought to have the best quality? “These are large private hospital chains, university hospitals and central hospitals – after that, nothing else comes.”
16 public hospitals in the canton of Bern have had to close in the past 25 years. And the change in the hospital landscape continues. Money and politics set the pace.
Regional Journal Bern, Fribourg, Valais, July 29, 2024, 5:30 p.m.;
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