Could one ambulatory surgery centre meet the needs of 1.5 million people?
A proposal to merge all ambulatory surgery care in Zurich into one location has provoked debate. We ask our contacts there what the thinking behind it is and whether it could work.
Andrea Rytz, CEO of the not-for-profit Schulthess Clinic which specialises in orthopaedic surgery, says that the spiralling deficit for ambulatory care clinics in Switzerland can be solved in one fell swoop.
“With one ambulatory centre for the appropriate surgical interventions, it is possible to meet the healthcare needs of all the citizens in the Zurich canton. Hospitals could use it to operate on patients at their own time and with their own surgeons.”
She says that this would better meet healthcare needs, as well as help with ambulatory care’s struggling margins.
“Whichever way you calculate it, only 85% of costs are covered in our sector,” she explains. This is because inpatient care is flat-rate remunerated, with prices set by cantons if no agreement is reached between providers and insurers. For outpatient, there is no regulatory intervention and tariffs are set according to work done.
Romain Boichat, healthcare business consultant in Switzerland, tells us that for private providers the EBITDA margin for inpatient care is as high as 20%, while in outpatient the best they can hope for is 6-10%. And for all outpatient care, the sector is in a deficit: 472 million Swiss Francs (€440m) in 2015 according to the Federal Office for Public Health.
He estimates that to serve Zurich canton’s 1.5 million citizens, Rytz’s ambulatory centre would need at least 20 operating rooms to perform 60,000 surgical procedures annually.
Paul Rhyn of Santesuisse, the largest association of insurers in Switzerland, says that two lines of thinking emerge as a solution. One is for ambulatory players to negotiate better tariffs with insurers. The other, as proposed by Rytz, is to use synergies to increase efficiency and cut costs.
“Right now there is not an efficient use of infrastructure in the sector. The most important thing is the quality of surgeon and team, not where the operation takes place,” Rhyn says. “Zurich has great transport links,” he says, agreeing that it is an ideal region to pilot such a program.
There are two major stumbling blocks to Rytz’s solution. The first is the lack of motivation for the Cantons, who are in large part the owners of the public hospitals, to join the scheme. The other problem that this is coming from a private, not-for profit practice; if it were a politician saying it more people might take notice.
The mega-hub of ambulatory care could either be a greenfield development or could be installed in an underused hospital in the city. Though, the second would be another stumbling block. Who wants to lose their local hospital?
We would welcome your thoughts on this story. Email your views to David Farbrother or call 0207 183 3779.
