the need of the hour is to Save in the Swiss health care system. Only, where and with whom to ask? Sunday view the latest Figures from the children’s hospitals are. And the state that is Saved at the expense of the Smallest.

In 2018, wrote to the six major children’s hospitals of Zurich, Basel, St. Gallen, Bern, Lausanne and Geneva for a total of 60 million Swiss francs deficit in the outpatient area. The are about ten percent more than the year before. In the case of the three independent children’s hospitals of Zurich, Basel and St. Gallen there are even 25 percent more.

Responsible for the children’s hospitals to make the Revision of the medical tariff Tarmed by SP Federal councillor Alain Berset (47). It entered into force on 1. January 2018 in force.

Tarmed specifies what medical benefits

may cost, “The children’s medicine is acutely threatened,” says Agnes genes wine (51), managing Director of the Alliance of children’s hospitals in Switzerland (AllKidS), in which the three stand-alone children’s hospitals have closed.

The controversial Tarmed is a contract between Doctors, hospitals and health insurance companies. He determines what must cost of medical services in the outpatient, non-stationary range: from blood collection through the consultation up to the x-ray examination.

The Tariff was introduced in 2004 and needs to be regularly revised. Can’t the collective bargaining partners to some, speaks to the Federal Council a power word. After 2014, he did this last year for the second Time: Minister of health Berset prescribed a tariff reduction, the efficiency of medical treatments to be increased.

a scale of the adult medicine

But what in the adult medicine, leads to, hopefully, cost reductions in the children’s medicine devastating. Genes wine: “The growing deficits of the children’s hospitals is the result of the Tarmed-intervention are transfers by the Federal Council.”

Tarmed is based on the adult medicine and follows the motto: x-ray examination x-ray examination is, no matter how old the Patient is.

“And that’s the Problem,” says gene wine. “Children’s medicine is much more complex and time-consuming than adult medicine.” What leads to the children’s hospitals are not able to comply with the Tarmed fixed time limits.

350’000 children of rare diseases,

affected The the three AllKidS children’s hospitals of Zurich, Basel and St. Gallen, especially to feel. About a third of their young patients suffering from rare diseases that require expensive treatment. Often it is genetic defects, or metabolic diseases.

In Switzerland are affected 350’000 children from a rare disease. You can not be in a practice, care. Specialists are only available in the children’s hospitals. “Tarmed are not taken into account,” says the neonatologist genes wine, which takes care of the children’s hospital of both Basel to New and premature babies. Then she tells the story of Fatima, there came in the spring of the world.

even before Fatima’s birth, it was clear that the girl does not suffer from a so-called migration disorders of the brain, your brain cells grow there, where they belong. After Fatima’s birth, the Doctors arrange a number of investigations. Including a magnetic resonance imaging, a procedure, the tissues and organs visible.

Two and a half hours instead of a half for the tomography

Because Fatima has serious respiratory problems, a need for you device in the Tomography, a special ventilation. These 40’000 Swiss francs expensive machine but it’s not in Basel. A wizard has to give Fatima is so out of Hand. To do this, he places the child in the Tomography. The Children’s radiologist starts the first sequence, neonatologist genes wine monitored Fatima from the outside. As soon as the child is moving, must have interrupted the sequence, and from the front start.

The procedure is time-consuming. And she needs time. At the end of two and a half hours to beat for the tomography to beech. In an adult it would be twenty minutes. “These twenty minutes are covered by Tarmed in Fatima’s case,” says gene wine. “The Rest is deficit.”

cases like this are there for you everyday.

cancer in children in 80 percent of cases can be cured

The performance of modern pediatric medicine is impressive. In the 1960s, no child survived cancer. Today, cancer in children is effective in 80 percent of cases can be cured. Kidney transplants for young patients to live a normal life, earlier, you were chained to the dialysis. Severe immune defects in children have led until recently to the death, because they have not been discovered. Since this year there is a newborn Screening that makes such Defects are visible and therefore treatable.

operations on the open back are today in the womb is possible. Also, the Situation for children, who can not be cured, has improved considerably: progress in palliative care allow you a pain-free and full Die in their own home would.

“But, of all things, these visits will be billed from Tarmed miserable,” says Michael Grotzer (55), the Medical Director of the children’s hospital of Zurich. It is a paradox: The modern children’s medicine is a success story. Just you may cost nothing.

Next overall revision 2021 effective

Particularly precarious is the situation for the AllKidS children’s hospitals is. So far, their deficits of foundations and the support of the cantons to be collected. But are no longer willing to pay more every year. Instead, the cantons are pushing for a Change in the tariff system. In mid-August, the health Commission of the Council of States will discuss several cantonal initiatives calling for an adjustment of the Tarmed.

The Federal office for health (BAG), sees no reason to correct the Federal Council’s collective engagement. It refers to the next overall revision. The planned Tarmed-the successor to the name of Tardoc, however, is at the earliest 2021 to take effect. Whether he brings for the children’s hospitals to improve is uncertain.
On the Tardoc the children’s hospitals don’t want to wait anyway. You demand a rapid adaptation of the Tarmed. Agnes gene wine: “Without a Change in the tariff structures, the AllKidS can’t survive children’s hospitals.” Thus, the research in the field of children’s medicine threatened to collapse.

Worse still, The children’s medical danger, behind the Reached to fall back to be running. Because of the treatments that are possible today could not be soon carried out. Because they are too expensive.
And in Switzerland – as measured by the per capita financial assets of the richest country in the world.

We all moan about the cost of healthcare. Surprised no-one has to, of course: The basis of calculation for the amount of medical treatment costs, are called Tarmed, and DRG. The latter is the acronym for “Diagnosis Related Groups”, in English: “diagnosis related groups”.

A word like pestilence!

someone Believes seriously that linguistic Monsters such as this, something Good looks?

the DRG concept of the American economy engineer Robert B. Fetter Invented. At the end of the 1960s, he said, the hospital to the factory. As the conveyor belt, so his thoughts would also be joined in the hospital the individual components into a finished product.

Until then, hospitals were seen as places where patients are cared for and Doctors your healing arts practice. Why fell Robert B. Fat on the mistaken idea, to downgrade the hospital to the factory?

With its method of the medical services themselves can be standardized. If a certain screw when the car still costs the same, should also have a certain medical intervention is always the same price. Certainly an appendectomy is more expensive than a glance in the throat – it consists of more components. However, no abdominal surgery should cost more than the other.

With Robert B. Fetter, the management came to think in terms of the medicine. Of the United States, the Virus spread gradually to other countries. In Switzerland, the “SwissDRG” for in-patient treatment in the hospital since 2012. A few years earlier had been introduced for outpatient services outside of the hospitals, the tariff system Tarmed, which also works according to the logic of the Assembly line, and equal to more expensive screw.

In the adjacent Text my colleague Danny smurf describes a glaring weakness of this principle. The Ill required more effort than the collective system, not attributed to the Whole. Are affected, especially children and old people. These particularly vulnerable patients the right treatment, but the supposedly most so often.

The bitter punch line is that the dominance of economic thinking in medicine is not only individual patient harm. No, the System is also, from a financial point of view, a fiasco.

The policy has introduced DRG and Tarmed, in order to get health costs under control. In fact, however, the equating of the hospital with a factory to the contrary.

think A economic doctor has to automatically be less the Welfare of the patient in the eye as the own profit. The patient, in turn, is instilled, health is nothing more than a consumer product. Healthy or who consumed as much as possible. So we consume all of the proficient, the healthcare market is growing and growing – and with it the cost.

Operation successful, Patient dead.