Swiss hospitals face collapse without urgent legal and financial reforms

Herisau Hospital and its Psychiatric Center face an uncertain future under current laws, threatening over 700 jobs. The cantonal government has now proposed a major revision of the Hospital Network Act to secure their operations. The plan includes transforming both facilities into independent companies while keeping them under public oversight.

The move aims to attract external funding and give the institutions more flexibility in managing their finances. Without changes, the hospitals risk closure due to mounting financial pressures and outdated legal structures.

The Appenzell Outer Rhodes government has outlined a comprehensive revision of the Hospital Network Act. If approved, the law would convert Herisau Hospital and the Psychiatric Center into two separate joint-stock companies. These entities would operate within the existing Appenzell Outer Rhodes Hospital Network (SVAR), which would retain a strategic oversight role.

The proposed amendments would grant the new companies greater operational autonomy. This includes the freedom to form partnerships, seek external investors, and make independent financial decisions. The government believes these changes are essential, as the Psychiatric Center requires around CHF 38 million in investments, while the acute-care hospital needs up to CHF 150 million in the coming years.

All current employees will transfer to the new structure under transitional arrangements designed to protect their existing employment terms. The legal revisions are expected to enter into force by 2028, but first, they must pass a consultation phase. Stakeholders and interested parties have until mid-May to submit feedback.

The financial struggles in Herisau reflect a broader crisis across Swiss healthcare. Other hospitals facing similar challenges include Spital Oberengadin in Graubünden, which survived with emergency credits but had to cut beds and staff. Kantonsspital Baselland reported a CHF 25 million loss in 2023, while St. Galler Spitäler recorded a deficit nearing CHF 100 million. Kantonsspital Baden experienced its weakest financial result in 12 years, and Thuner Spitalunternehmen in Simmental also ran a deficit. Even Kinderspital Zürich requires a CHF 100 million rescue package. Cantons such as Graubünden, Basel-Landschaft, St. Gallen, Aargau, Bern, and Zürich have been particularly affected by these financial pressures.

The proposed legal changes aim to secure the future of Herisau's hospitals by enabling greater financial independence and external investment. If implemented, the revisions could prevent job losses and ensure continued healthcare services in the region. The next step involves gathering feedback during the consultation phase before any final decisions are made. The outcome will determine whether the hospitals can avoid closure and stabilise their operations in the long term.