Cun 162,5 milliuns francs furma il sectur da sanadad tenor il quint annual 2000 la quart gronda summa d'expensas. Quai correspunda ad ina part da 9 pertschient da las expensas totalas. L'introducziun da la lescha federala davart l'assicuranza da malsauns (LAM) per il 1. da schaner 1996 ha per consequenza ina nova organisaziun dal sectur da sanadad. Quests dus fatgs giustifitgeschan in'analisa da la situaziun sin plaun chantunal. I sa tracta surtut da la transparenza en il svilup dals custs en il chantun Graubünden.
Nus preschentain perquai las sequentas dumondas a la regenza:
1. Co èn sa sviluppads ils sequents facturs en il chantun Grischun:
- expensas da las clinicas, las chasas da tgira e dals ospitals subvenziunads?
- retgav da las clinicas, las chasas da tgira e dals ospitals subvenziunads?
- contribuziuns chantunalas per clinicas, chasas da tgira ed ospitals subvenziunads?
- premias medias chantunalas per l'assicuranza da basa per la tgira da malsauns?
- contribuziuns ad ospitalisaziuns e plazzaments extrachantunals?
2. Ils purtaders principals dals custs sin il sectur da sanadad èn il chantun ed ils assicuraders da malsauns. Èn vegnids fatgs transferiments dals custs tranter il chantun ed ils assicuraders da malsauns u viceversa dapi l'introducziun da la LAM? En cas da gea, tgenins ed en tge dimensiun?
3. Il chantun Grischun vegn ad esser confruntà en il futur cun augments considerabels dals custs. Exempels:
- Sut il chavazzin "Cunvegna da moratori" èn pendentas decisiuns da dretgiras che vegnan ad obligar il chantun da surpigliar custs da 15 fin 20 milliuns francs.
- Diversas reglamentaziuns novas en la lescha da lavur ch'è en vigur dapi il 1. d'avust 2000 sin ils secturs protecziun da sanadad, temps da lavur e da ruaus e protecziun da la maternitad chaschunan dapli custs. Gia la restricziun dal temp da lavur per ils medis assistents ed ils medis superiurs chaschuna in augment dals custs presumtivs da quatter fin sis milliuns francs per onn en il chantun Grischun.
- Meglieraziun da las cundiziuns d'engaschament dal persunal sin il sectur da sanadad. Qua èsi da quintar a l'entschatta cun custs da circa tschintg milliuns francs. Cun tge ulteriurs custs èsi da quintar per restabilir la cumpetitivitad cun la Svizra bassa sin il martgà da lavur?
- Consequenzas da la revisiun LAM-2.
Gia quests exempels chaschunan in augment dals custs da circa 30 milliuns francs. Quai èn var 10 pertschient da las entradas fiscalas da las persunas natiralas dal chantun Grischun.
Quant auts èn ils custs totals ch'èn oz conuschents e ch'èn da spetgar tenor il giudicat da la regenza? Tge pussaivladads d'agir ha la regenza concernent la grevezza da quests custs respectivamain la distribuziun tranter ils purtaders dals custs?
Cuira, ils 31 da matg 2001
Nick, Portner, Hardegger, Battaglia, Bischoff, Bühler, Büsser, Cahannes, Capaul, Casanova (Cuira), Casanova (Vignogn), Cathomas, Catrina, Cavegn, Cavigelli, Christ, Christoffel, Claus, Dalbert, Demarmels, Federspiel, Feltscher, Frigg, Geisseler, Giuliani, Gross, Jäger, Jenny, Joos, Juon, Kehl, Keller, Kessler, Koch, Kollegger, Lardi, Lemm, Locher, Loepfe, Luzio, Maissen, Marti, Parpan, Peretti, Pfenninger, Quinter, Righetti, Rizzi, Robustelli, Sax, Schmid (Spleia), Schmid (Val S. Pieder), Schmutz, Schütz, Suenderhauf, Suter, Thomann, Trachsel, Tremp, Tuor (Trun), Valsecchi, Vetsch, Walther, Wettstein, Zanolari, Zegg, Zindel
Session: 01.06.2001
Vorstoss: rg Interpellation
<p><b>Resposta da la regenza</b></p>
<p> 1. Ils facturs dumandads &egrave;n sa sviluppads sco suonda:</p>
<p><b>Expensas e retgav dals ospitals e da las clinicas subvenziunadas</b></p>
<table width="600" border="1" cellspacing="0" cellpadding="0">
<tr>
<td width="164">Quints d'ospital</td>
<td width="86">1996</td>
<td width="83">1997</td>
<td width="84">1998</td>
<td width="91">1999</td>
<td width="78">2000</td>
</tr>
<tr>
<td>Expensas pli stretgas dal manaschi </td>
<td>210'255'741</td>
<td>216'105'455</td>
<td>218'179'673</td>
<td>217'608'828</td>
<td>224'226'829</td>
</tr>
<tr>
<td>Retgav pli stretg dal manaschi </td>
<td>162'400'005</td>
<td>159'962'231</td>
<td>163'640'402</td>
<td>159'166'551</td>
<td>167'465'860</td>
</tr>
</table>
<p><b>Expensas e retgav da las chasas da tgira e partiziuns da tgira subvenziunadas
</b> </p>
<table width="600" border="1" cellspacing="0" cellpadding="0">
<tr>
<td width="185">Quints da chasas da tgira</td>
<td width="77">1996</td>
<td width="77">1997</td>
<td width="79">1998</td>
<td width="94">1999</td>
<td width="74">2000</td>
</tr>
<tr>
<td>Expensas pli stretgas dal manaschi</td>
<td>61'871'403</td>
<td>63'478'848</td>
<td>64'115'508</td>
<td>67'000'601</td>
<td>71'136'953</td>
</tr>
<tr>
<td>Retgav pli stretg dal manaschi </td>
<td>50'785'291 </td>
<td>51'764'986 </td>
<td>58'261'257 </td>
<td>64'963'804</td>
<td>70'150'363</td>
</tr>
</table>
<p> <b>Contribuziuns chantunalas ad ospitals e clinicas</b></p>
<table width="600" border="1" cellspacing="0" cellpadding="0">
<tr>
<td>Quint dal stadi</td>
<td>1996</td>
<td>1997</td>
<td>1998</td>
<td>1999</td>
<td>2000</td>
</tr>
<tr>
<td>&nbsp;</td>
<td>37'196'156 </td>
<td>47'431'651</td>
<td>57'628'859</td>
<td>46'536'499</td>
<td>53'267'349</td>
</tr>
</table>
<p> Il ferm augment l'onn 1998 sa basa sin in ferm augment dal deficit dals ospitals
l'onn 1997.</p>
<p><b>Contribuziuns chantunalas a chasas da tgira e partiziuns da tgira</b></p>
<table width="600" border="1" cellspacing="0" cellpadding="0">
<tr>
<td>Quint dal stadi</td>
<td>1996</td>
<td>1997</td>
<td>1998</td>
<td>1999</td>
<td>2000</td>
</tr>
<tr>
<td>&nbsp;</td>
<td>11'208'403</td>
<td>8'888'774</td>
<td>8'665'230</td>
<td>3'056'579</td>
<td>- 78'165 *</td>
</tr>
</table>
<p> La summa negativa da l'onn 2000 resulta da la scuntrada dals pajaments anticipads
ch'&egrave;n stads pli auts ch'ils deficits pli stretgs dal manaschi.</p>
<p><b>Premias annualas medias en il chantun per l'assicuranza da basa per la tgira
da malsauns</b></p>
<table width="600" border="1" cellspacing="0" cellpadding="0">
<tr>
<td>&nbsp;</td>
<td>Uffants</td>
<td>Giuvenils en scolaziun</td>
<td>Creschids</td>
</tr>
<tr>
<td>1996</td>
<td>384 </td>
<td>972 </td>
<td> 1416</td>
</tr>
<tr>
<td>1997</td>
<td>432 </td>
<td>1092 </td>
<td> 1656</td>
</tr>
<tr>
<td>1998</td>
<td>456</td>
<td>1212 </td>
<td>1740</td>
</tr>
<tr>
<td>1999</td>
<td>432</td>
<td>1116</td>
<td>1776</td>
</tr>
<tr>
<td>2000</td>
<td>480 </td>
<td>1176 </td>
<td>1860</td>
</tr>
<tr>
<td>2001</td>
<td>513</td>
<td>1323</td>
<td>2016</td>
</tr>
</table>
<p><b>Contribuziuns dal chantun ad ospitalisaziuns extrachantunalas</b> </p>
<table width="600" border="1" cellspacing="0" cellpadding="0">
<tr>
<td>1996</td>
<td>1997 1)</td>
<td>1998 </td>
<td>1999</td>
<td>2000 2)</td>
</tr>
<tr>
<td>4'339'122 </td>
<td>14'081'439</td>
<td>7'998'478</td>
<td>10'123'581</td>
<td>14'889'144</td>
</tr>
</table>
<p> 1) inclus ils pajaments posteriurs / las reservas per pazients privats e mezprivats
sin basa da la sentenzia da la dretgira federala d'assicuranzas dals 16 da december 1997<br>
2) inclus ils pajaments posteriurs da fr. 2'037'576 (ospital da l'universitad
a Turitg, Triemli) sin basa dal &quot;rendaquint da clearing&quot; da la CDS-ost per l'onn 1997<br>
</p>
<p>2. La participaziun dals assicuraders da malsauns e dal chantun als custs dals
ospitals e da las cha-sas da tgira &egrave; sa svilupp&agrave; sco suonda:</p>
<p><b>Ospitals </b></p>
<table width="600" border="1" cellspacing="0" cellpadding="0">
<tr>
<td>&nbsp;</td>
<td>1996</td>
<td>1997</td>
<td>1998</td>
<td>1999</td>
<td>2000</td>
</tr>
<tr>
<td>Expensas assicuraders </td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>Staziunar</td>
<td>72'890'000</td>
<td>80'006'000 </td>
<td>86'127'000</td>
<td>91'081'000 </td>
<td>92'903'000</td>
</tr>
<tr>
<td>Ambulant</td>
<td>15'681'000</td>
<td>18'440'000</td>
<td>21'480'000</td>
<td>24'098'000</td>
<td>27'231'000</td>
</tr>
<tr>
<td>Total assicuraders</td>
<td>88'571'000</td>
<td>98'446'000 </td>
<td>107'607'000 </td>
<td>115'179'000 </td>
<td>120'134'000</td>
</tr>
<tr>
<td>Expensas chantun</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>Contribuziun chantunala</td>
<td>41'052'485</td>
<td>48'826'972</td>
<td>46'676'713</td>
<td>50'459'357</td>
<td>48'718'372 </td>
</tr>
<tr>
<td>Ospitalisaziuns extrachantunalas </td>
<td>4'339'122</td>
<td>14'081'439</td>
<td>7'998'478</td>
<td>10'123'581</td>
<td> 14'889'144</td>
</tr>
<tr>
<td>Total chantun</td>
<td>45'391'607</td>
<td>62'908'411</td>
<td>54'675'191 </td>
<td>60'582'938</td>
<td>63'607'516 </td>
</tr>
<tr>
<td> Chantun en % dals assicuraders</td>
<td>51%</td>
<td>64%</td>
<td>51%</td>
<td>53%</td>
<td>53%</td>
</tr>
</table>
<p>En il sectur da la finanziaziun dals ospitals n'&egrave; result&agrave; nagin
spostament essenzial dals custs tranter il chantun ed ils assicuraders da malsauns.</p>
<p><b>Chasas da tgira </b></p>
<table width="600" border="1" cellspacing="0" cellpadding="0">
<tr>
<td>&nbsp;</td>
<td>1996</td>
<td>1997</td>
<td>1998</td>
<td>1999</td>
<td>2000</td>
</tr>
<tr>
<td>Expensas assicuraders </td>
<td>6'855'000</td>
<td>11'055'000</td>
<td>12'560'000</td>
<td>15'291'000</td>
<td>19'267'000</td>
</tr>
<tr>
<td>Expensas chantun </td>
<td>8'869'774 </td>
<td>9'377'230</td>
<td>5'351'979 </td>
<td>2'677'506</td>
<td>2'161'358</td>
</tr>
<tr>
<td>Chantun en % dals assicuraders</td>
<td>129%</td>
<td>85% </td>
<td>43%</td>
<td>18% </td>
<td>11%</td>
</tr>
</table>
<p>Da la realisaziun graduada da la LAM concernent surpigliar ils custs per la
tgira tras ils assicuraders da malsauns &egrave; result&agrave; in spostament
da las grevezzas dal chantun als assicuraders.</p>
<p>3. La concessiun dal supplement dal martg&agrave; da lavur sin il sectur da
tgira che la regenza ha conclud&igrave; il zercladur vegn a chaschunar in augment
da las expensas per il persunal en ils ospitals per ca. 2.7 milliuns francs,
en las chasas per ca. 1.5 milliuns francs ed en las organisaziuns da spitex
per ca. 0.5 milliuns francs per onn. La realisaziun da la lescha da lavur revedida
vegn a chaschunar expensas supplementaras en la dimensiun da ca. 8 - 10 milliuns
francs be en il sectur dals medis assistents e dals medis superiurs. Ina participaziun
als custs tar tractaments en ospitals entaifer il chantun en la partiziun privata
e mezprivata chaschunass custs supplementars en l'import d'ulteriurs 15 - 20
milliuns francs per il chantun. Ils effects da la 2. revisiun da la LAM na pon
anc betg vegnir giuditgads. </p>
<p> La repartiziun dals custs supplementars &egrave; da fixar da princip en il
rom da las prescripziuns da la <br>
LAM tranter ils assicuraders da malsauns ed ils ospitals resp. las chasas da
tgira. Ils contracts da <br>
tariffas concludids ston vegnir approvads da la regenza. Ella sto examinar sch'il
contract da tariffa <br>
correspunda a la lescha ed a la devisa da la rentabilitad e duaivladad. Na datti
nagin contract da <br>
tariffas tranter ils partenaris da tariffa, ha la regenza da fixar la tariffa.
Avant ses conclus ha la re-<br>
genza da dumandar la posiziun dal survegliader da pretschs. Cunter ils conclus
da tariffa da la re-<br>
genza pon ins recurrer al cussegl federal. </p>