Initiative text for the
„Single Health Insurance“ (SHI)
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Meaning of the abbreviations in the initiative text (for space reasons):1002x
EKK = Unified Health Insurance Fund
EPD = Electronic Patient Dossier
KVG = Health Insurance Act
LE = Service providers (medical practices, hospitals etc.)
MF = MEDIFACT – the digital intelligence of the Unified Health Insurance Fund.
VA = Reimbursement request – service providers no longer issue invoices. They request MEDIFACT to calculate and reimburse services rendered.
VN = Policyholder
VVG = Insurance Contract Act.
The Federal Constitution Art. 117 para. 2 shall read as follows:
1) The Confederation establishes on its infrastructure the triply redundant, accessible and digital Unified Health Insurance Fund (EKK). It ensures that it begins operation three years after the acceptance of this provision. It immediately begins the costly development of MEDIFACT (MF), the electronic patient dossier (EPD) and the necessary trackers.
1a) Principle
The EKK is mandatory for all persons residing in Switzerland. Persons who emigrate lose protection; their access to the EPD remains.
1b) Exceptions
Anyone who proves a private health insurance according to the VVG, which fully covers the benefit catalogue of the EKK, is exempt from membership of the EKK for its duration. Upon expiry or invalidity of the policy, membership of the EKK automatically comes into force again. In addition to the EKK, a VVG policy may exist solely for alternative medicine.
2) Organisation of the EKK
The EKK consists of three departments:
– MEDIFACT (MF).
– Electronic Patient Dossier (EPD).
– Financial Administration (FV).
The AHV number serves as the insurance number and EPD access code. Authorized persons contact the EKK online, by email or via the free phone number.
3) Personnel
Patient-related personnel and laboratories declare their education and experience to MF; MF calculates their possibly different remuneration value.
4) Benefits
The EKK covers all KVG benefits and non-occupational accidents
Plus:
– no costs for minors
– no deductibles
– free choice of doctor – not in hospitals
– breast cancer prevention
– reimbursement of physician-prescribed imported medicines
– emergency and patient transport within Switzerland
– dental services (except dental cleaning and medically unnecessary dentures).
Single-room surcharges for self-paying patients are possible.
5) MEDIFACT MF
MF is the digital intelligence of the EKK.
MF assigns case numbers FN.
MF checks legality, directs operations, prevents abuse and produces reports in all languages. Everything fact-based and neutral.
MF sets remuneration for equipment, rooms and special skills.
MF promotes satisfied personnel and affordable family care.
MF stores wills, advance directives and organ donation declarations.
MF informs all patients in detail and in their language about upcoming payments to their LE. Only with their consent is payment triggered or delegated. All data, images and (only) important voice recordings flow into the EPD. Unnecessary items are deleted.
6) Basic remuneration per full hour
– Ø Fr. 200.- for medical staff
– Ø Fr. 130.- for nursing. Other KVG eligible services: cost price plus 20%.
7) Monthly premium
Always Fr. 150.-. Annual inflation is paid separately.
8) Remuneration system
MF calculates remuneration based on personnel tracker data, costs and lump sums. Fees of private clinics remain free. Participation and direct payments are prohibited.
9) Electronic patient dossier, stored in Switzerland
Patient health data from all LE and all entries from existing dossiers must be integrated into the EPD of the EKK. Before every treatment the EPD must be consulted. Accesses and changes are shown to patients.
10) Economic stability
MF periodically examines the economic efficiency of LE and ensures sustainable financing through tariff adjustments if necessary.
11) Financing
Any losses of the EKK are borne by the Confederation. Compensation: the cantons no longer pay hospital financing.
12) Financial administration
The FV collects premiums. Automation allows a small workforce.
13) Further legislative changes
– KVG Art. 43, 49 and 49a are repealed.
– UVG Art. 7 para. 2 is repealed. It is replaced by OR 324a.
– Existing KVG funds are dissolved. Their reserves and patient data are transferred to the EKK and the EPD.
14) Where nothing else is regulated here, the remaining laws continue to apply.
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