Green light for Swiss national health insurance

% of the cases, and 60%, of the Green for Swiss patients have no other medical contact than units he FFI or the resident (medical student). A national health insurance urvey of 207 hospitals in 1992 revealed that 0% of the emergency units operate withToo many emergency units in France have mt a senior doctor, and that 68% of themThe approval by some 80% of Swiss in a too few doctors, and the system is clogged iave a medical team of fewer than 5. Yet nationwide referendum (Sept 25-26) of a up by too many patients. In 1990 the vacancies in emergency units do not attract SwFrlO (4.65) daily charge payable by all country had 566 emergency units in 524 applicants because, according to the report, hospital patients irrespective of whatever public hospitals. There is approximately lectors perceive that the units are not a health insurance they may have has given one public hospital receiving emergency sufficiently stimulating medical environthe green light for the introduction of a patients per 141000 inhabitants, or one nent, that they lack access to technical uniform system throughout the country. emergency unit per 105 000 inhabitants. 1 : facilities, and that a "critical mass" of Discussion of draft legislation to this end French citizen out of 8 visits such a unit action does not take place in many of these began in parliament on Sept 30. The annual each year and 2345 000 of them are units. The system has not collapsed only maximum payable by an individual under admitted to hospital after their visit (a rate because of help from anaesthesia and the new SwFrlO charge is SwFr500, pendof admission of 32-2%). A report presented intensive-care units and because ing parliamentary approval of global last week to the Ministers of Health and staff know how to seek out such help. : compulsory sickness insurance, bringing Social Affairs by the Commission for the Switzerland into line with most other West Steg and his colleagues propose a reRestructuring of the Emergency Units says grouping of emergency units, as allowed by European countries. Meanwhile the that the lack of organisation of these units v a 1975 law. There should be only one unit SwFrlO charge will, it is hoped, put a brake and the way they are used are such that it is a per 300 000 inhabitants and units should be on rising and widely varying premiums as miracle that mishaps have not occurred either reception units, with at least 5 senior charged by the country’s 200 or so main more frequently or been more serious. The doctors trained to do highly specialised and insurance funds. commission is presided over by Prof complex procedures, or screening units, Application of the decree on curbing Adolphe Steg (Hopital Necker, Paris), who with fewer senior doctors to undertake rising health costs, approved by parliament in 1989 prepared a report on emergency most of the other medical work, including last October, had been held up pending the units for the Economics and Social outpatient consultations. In addition, the outcome of the referendum. About 98% of : public would be taught not to rush to the the 6-8 million population are covered, in Council. The commission notes not only the rise nearest hospital but to dial "15"formedical part or wholly, by the funds, most of in numbers of patients attending emergadvice. The "15" centres already exist in which receive state subsidies. From 1985 to units a increase in Strassome French regions and would have to be = last year, health costs went up by more ency (eg, 300% the 10 over extended to all regions. but : than 45%. With varying coverage percentbourg hospitals years) past also the point that at least 70% of cases seen Other recommendations include moniage, an estimated 30% of overall family are not emergencies. Part of the reason toring of the activity of emergency units health expenditure is not refunded by seems to be the non-availability of general (using indicators such as number of visits, insurance. rate of admission, length of visits, number The legislation being drafted is expected practitioners (in Normandy, 75% of nonhospital doctors allocate under 5 % of their of medical and surgical procedures); that to institute a basic standard premium for working hours to emergencies) and partly = units be an independent department whose all, irrespective of age or sex (the trend has v to the way patients see emergency units as a budget should be individualised; and that been for women to pay more) and to include supermarket for tests and X-rays. The they have adequate numbers of permanent an equalisation fund, as approved by parliastaff. Money will be required to finance the : ment in 1991, for sharing out risks between commission notes that emergency doctors trained in the specialty to DES (Diplome restructuring. After that, the commission the insurance funds. Parliament hopes to d’Etude de Specialite) level are found only recommends that units receive negotiated have the new scheme operative in 1995. in university hospitals. The bulk of the sums to meet specified objectives. The: The national referendum also approved work is done by FFI (Faisont Fonction restructuring, says Steg, should not be legislation with an entirely direct bearing d’Interne) students acting as interns; they bureaucratic; there should be flexibility for on health-this provides for stricter control do 50-63% of the night shifts but only 23% units to adapt to their needs. : over gun sales. of them have the ability to do so. The final decision in surgical emergencies was taken Jean-Michel Bader Alan McGregor

Revamp of emergency

light

IY them in 37

existing

the employers nor the Social Democrat Party which enjoys a majority in the Penalty fees and Council of the Federal States ("Buntables desrat") said they would accept this law.

nor

Financing residential for the elderly

care

league

Since the Bundesrat must approve the plan before it can become law, their vote counts. The German government has for several And the Bundesrat has already indicated Since April this year the pressure on UK months been trying, but without success, to that it would not accept the new plan either. health authorities to reduce waiting lists has find a means of financing health care for the The unions are threatening to strike in intensified. Previously the government’s elderly. The latest plan proposes that all protest at this "involuntary, government- Patient’s Charter put a time limit of 2 years workers and employees be legally obliged imposed pay cut". They are angry that the on the waiting time for an operation; since to give up either 2 days of their paid proposed law would mean that workers and April this deadline has been reduced to 18 holidays or accept a 20%pay cut on all 9 employees would carry the whole financial months. A new scheme by the Department German public holidays. : burden of the new insurance. The of Health to ensure that the Charter’s This proposal was made after the pre- : Christian Democrat/Liberal government is committments are adhered to involves vious plan-under which employees would nevertheless determined to push ahead "clawing back" money from a regional not have received pay for the first 2 days of with their plan. health authority if a patient is not treated illness (see Lancet July 10, p 107)-had within the set time limit. The money that is failed to win approval. Neither the unions Annette Tuffs reclaimed comes not from the regional

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