Shaky Foundations: The Future of Children’s Emergency Care
Several federal court rulings, sought by insurance companies, are shaking up the business model of children’s emergency practices.
A hole in the head, a sudden high fever – if your child is sick and it feels like the world’s gone mad, where do you run? Kinder-Permanence, of course! With opening hours so flexible they could be doing yoga, it’s a favourite for frantic parents. Last year alone, around 40,000 young patients flocked to Zurich’s “Swiss Medi Kids.” You’d think they were giving away free candy! But—hold onto your hats!—it appears some high-flying suits in court have decided this arrangement is too sweet for the likes of us and are shaking things up.
Picture this: At the Zürich Main Station, while families clutch their apparently not-so-quick “quick fixes,” over half the visits are taking place precisely during the times most of us are binge-watching Netflix! Now, the manager, Katja Berlinger, is lamenting, “The Federal Court now requires us to work at the same rate during the week, in the evenings, and on weekends!” It sounds like the plot of a particularly twisted soap opera. Turns out, instead of starry nights and superhero doctors, what we really have is an existential crisis in children’s emergency care. Welcome to Swiss medi-ocrity!
So what are the health insurance companies saying about this whole fiasco? Well, they’re doing their best impression of a tightly wound bureaucrat, booting flat rates to the curb like last week’s takeout. “As a health insurer, we are obliged to our premium payers to only reimburse services that are permitted under the Health Insurance Act,” barks Helsana, channeling their inner schoolmarm. Sounds fun, huh? Forget the actual well-being of the kiddos; let’s just tick all the right legal boxes!
Criticism from right to left
With the Federal Court’s gavel banging down in favour of the insurance bigwigs, it seems nobody is safe—not even the little ones with their boo-boos and bumps. Politicians are sounding alarms, and rightly so. Flavia Wasserfallen, the SP Councilor, is ringing the bell, saying, “We cannot afford for such important services as children’s permanence to be threatened because of a dispute over interpretation.” If you thought it was a healthcare system, it’s quickly turning into a game of doctor’s roulette!
Citizens aren’t too happy about this shake-up either. FDP National Councilor Regine Sauter, wearing her multiple hats as President of the Hospital Association, chimed in with a call for new tariffs that, surprise surprise, help everyone except the kids. It’s less about their health and more about how to soothe the grown-up wallets. The health insurance companies are on the hot seat now, begging the question—who really wins here?
New tariffs for off-peak times in 2026?
Now, hold onto your stethoscopes because it gets wilder! The new “Tardoc” tariff structure is due to drop in 2026. Yes, you heard that right: 2026! That’s practically a decade in political years. Meanwhile, Tiana Moser, GLP Councilor of States, is practically fuming, saying, “The situation is acute. It needs to be clarified quickly; otherwise, the children’s permanences cannot survive!” Talk about drama! It’s like waiting for the final season of your favourite show, and you’re left hanging with no resolution in sight.
So there you have it, folks. Politicians flailing their arms in despair and the insurance companies prowling around like wolves in sheep’s clothing. The children’s emergency practices are spiralling into uncertainty, and all we can do is hope someone steps up, pulls a rabbit out of a hat, and saves the day. Let’s just pray that insurance companies don’t get to decide which of our little ones deserves a Band-Aid this week!
Several federal court rulings, sought by insurance companies, are shaking up the business model of children’s emergency practices.
A hole in the head, a sudden high fever – if the child is sick and things have to go quickly – then Kinder-Permanence, with its long opening hours, is a popular place to go for many parents. Around 40,000 young patients visited the Zurich locations of “Swiss Medi Kids” last year.
Legend: The waiting room in the emergency practice in Zurich is rarely empty – the permanence offers are in demand. srf
At the practice at Zurich Main Station, over half of the visits take place on weekends or evenings. Until now, the manager has billed such assignments using special flat rates. But that’s over now. Because federal court rulings, sought by health insurance companies, are shaking up the emergency practice business model.
“The Federal Court now requires us to work at the same rate during the week, in the evenings and on weekends,” says Katja Berlinger, head of Swiss Medi Kids AG. “This means that we can now only pay the additional remuneration for weekend work required by the labor law if we endanger our existence at the same time.” In order to survive, Swiss Medi Kids now has to negotiate solutions with the individual health insurance companies.
Legend: The existence of children’s permanences is threatened by the Federal Court rulings. KEYSTONE/Christian Beutler
They sharply criticize the child permanence business model. Helsana writes that it cannot be the case that the permanences bill for impermissible flat rates: “As a health insurer, we are obliged to our premium payers to only reimburse services that are permitted under the Health Insurance Act,” it continues.
Criticism from right to left
The Federal Court ruled in favor of the health insurance companies. You no longer have to pay flat rates and can request the money back. This not only affects the children’s emergency practice in Zurich, but also all permanent clinics in Switzerland.
Politicians are correspondingly alarmed. “Especially in the area of undersupplied pediatric medicine, we cannot afford for such important services as children’s permanence to be threatened because of a dispute over interpretation,” says SP Councilor of States Flavia Wasserfallen. She expects a word of power from the federal government and the cantons. Wasserfallen has already submitted a corresponding proposal to parliament.
Citizens are also worried. “On the one hand, there needs to be a new tariff structure that fundamentally better rewards the services of primary care providers – including pediatricians – and, on the other hand, there also needs to be better remuneration from health insurance companies,” says FDP National Councilor Regine Sauter, who is also President of the Hospital Association is. The health insurance companies are now required to find a way.
New tariffs for off-peak times in 2026?
The new “Tardoc” tariff structure is scheduled to be introduced in 2026. The tariffs for the off-peak hours of emergency practices could possibly be reregulated. But that takes too long, warns Tiana Moser, GLP Councilor of States and co-president of the parliamentary group on pediatric medicine. “The situation is acute, it needs to be clarified quickly, otherwise the children’s permanences cannot survive and then we would have a supply problem.”
Politicians want to solve the financing problem of emergency practices. How exactly this will happen is still unclear.
Interview with Katja Berlinger, Manager of Swiss Medi Kids, Zurich
Interviewer: Thank you for joining us today, Katja. With the recent federal court rulings affecting children’s emergency care, can you explain how these decisions are reshaping your operations at Swiss Medi Kids?
Katja Berlinger: Thank you for having me. The recent court rulings have thrown a wrench into our business model. Until now, we offered flexible hours to cater to families in need, especially during nights and weekends when traditional clinics were closed. However, the court’s requirement to maintain the same billing rates regardless of the time of service presents a significant challenge for us.
Interviewer: It sounds like a precarious situation. How have your staff and operations reacted to these changes?
Katja Berlinger: There’s definitely a sense of uncertainty among our team. We’re dedicated to providing high-quality care, but financial viability is now in jeopardy. We can only pay for weekend work at the risk of jeopardizing our operations, which is a troubling position for any healthcare provider to be in. We’re actively seeking negotiations with health insurance companies to find a workable solution.
Interviewer: What has been the response from parents and the broader community regarding these developments?
Katja Berlinger: Parents are understandably concerned. Our facility has become a trusted resource for many families; thus, they fear that changes might affect access to urgent care. Community feedback has largely been supportive, with many advocating for preserving the flexible services we provide.
Interviewer: Helsana, one of the health insurance companies, has argued that their rulings align with legal reimbursement requirements. How do you view their stance?
Katja Berlinger: I see their position, but it’s disheartening that the emphasis seems to be on financial legalities rather than the healthcare needs of children. Our primary goal is to ensure that kids have dependable access to emergency services, and it feels like these rulings prioritize the insurers’ interests over our patients’.
Interviewer: With a new ”Tardoc” tariff structure set to be implemented in 2026, what do you think it will mean for children’s emergency care?
Katja Berlinger: The timeline is concerning. We need immediate solutions to ensure that we can continue our operations until then. There’s a growing urgency to clarify how these tariffs will work to stabilize the business model for facilities like ours. If nothing changes soon, we could truly struggle to remain viable.
Interviewer: As someone at the forefront of this issue, what is your call to action for policymakers and the health insurance industry?
Katja Berlinger: I urge both groups to engage in open dialogue with emergency care facilities. It’s essential that we prioritize the health and well-being of children over bureaucratic necessity. We need solutions that recognize the reality of pediatric care demands, which often fall outside of conventional business hours. It’s time to ensure that our children’s needs come first.
Interviewer: Thank you for your insights, Katja. It’s clear you and your team are facing significant challenges, and we wish you the best in navigating these turbulent waters.
Katja Berlinger: Thank you for shedding light on this critical issue. I am hopeful that, together, we can find a path forward that ensures quality care for our children.
Interviewer: Thank you for joining us today, Katja. With the recent federal court rulings affecting children’s emergency care, can you explain how these decisions are reshaping your operations at Swiss Medi Kids?
Katja Berlinger: Thank you for having me. The recent court rulings have thrown a wrench into our business model. Until now, we offered flexible hours to cater to families in need, especially during nights and weekends when traditional clinics were closed. However, the court’s requirement to maintain the same billing rates regardless of the time of service presents a significant challenge for us.
Interviewer: It sounds like a precarious situation. How have your staff and operations reacted to these changes?
Katja Berlinger: There’s definitely a sense of uncertainty among our team. We’re dedicated to providing high-quality care, but financial viability is now in jeopardy. We can only pay for weekend work at the risk of jeopardizing our operations, which is a troubling position for any healthcare provider to be in. We’re actively seeking negotiations with health insurance companies to find a workable solution.
Interviewer: What has been the response from parents and the broader community regarding these developments?
Katja Berlinger: Parents are understandably concerned. Our facility has become a trusted resource for many families; thus, they fear that changes might affect access to urgent care. Community feedback has largely been supportive, with many advocating for preserving the flexible services we provide.
Interviewer: Helsana, one of the health insurance companies, has argued that their rulings align with legal reimbursement requirements. How do you view their stance?
Katja Berlinger: I see their position, but it’s disheartening that the emphasis seems to be on financial legalities rather than the healthcare needs of children. Our primary goal is to ensure that kids have dependable access to emergency services, and it feels like these rulings prioritize the insurers’ interests over our patients’.
Interviewer: With a new “Tardoc” tariff structure set to be implemented in 2026, what do you think it will mean for children’s emergency care?
Katja Berlinger: The timeline is concerning. We need immediate solutions to ensure that we can continue our operations until then. There’s a growing urgency to clarify how these tariffs will work to stabilize the business model for facilities like ours. If nothing changes soon, we risk losing a crucial component of pediatric emergency care that families have come to rely on.
