In the midst of a summer break, we learned that the Vaud government planned to operate drastic cuts in health from 2026, undermining health establishments which benefit the most from “services of general interest” (PIG), which are direct subsidies and which represent between 500 and 600 million francs per year. Admittedly, the Vaud Council of State has been telling us for six months that its finances are bad, that it is necessary to save; And this is where the Department of Health and Social Action (DSAS) saw the best budget line where plans millions.
With what consequences? First of all, let’s see what these pigs correspond to. This is a financing mechanism for specific public health missions provided since 2012, clearly defined in the modification of the Federal Health Insurance Act (LAMAL) at the time. The revised law had introduced a radical change in hospital planning. Each canton had to establish its list of public hospitals but also private – which, as early as 2012, also benefited from state financing. The cantons took charge of 55% of the hospital invoice, the 45% insurers, therefore, moving from the cost reimbursement of a price system. The remuneration of stationary treatments has been carried out since then through packages by case linked to the services, based on uniform tariff structures for the whole of Switzerland.
To further complicate the situation, the project to finance uniform EFAS services, voted in November 2024, introduces so -called monist funding where hospital and outpatient services will be funded in the same way – 26.9% by cantons and 73.1% by insurance. But that does not change the famous pigs. These services compensate for the maintenance of hospital capacities for reasons of regional policy and equity in accessibility to health, research and university training. The cantons, which are sovereign in terms of health policy, have not all invested the same sums in pigs. The canton of Vaud has chosen to maintain local care structures, in particular in the Valley of Joux or the Pays d’Enhaut, and to support the CHUV and the Faculty of Medicine of the University of Lausanne to make it the pole of excellence that it really is.
The political right did not stop criticizing these pigs, and the court of accounts of the canton established a report in 2023 which pointed out a vagueness in the use of these subsidies and sometimes in the governance of beneficiary institutions. Since then, the DSAS has accompanied the foundation councils in the direction wanted by the Court of Auditors and major changes have been made.
Everyone has put their own by trying to find how to combine quality of local care and budgetary rigor. Thus in the land of embraces, 15 people were dismissed or their position was not renewed in 2024 and medium -term steering was clearly defined. But with the announcement of 4.6 million subsidy less for 2026, a decrease of 23% compared to 2025, the future of this hospital structure (which more and more has the appearance of a medical permanence with 12 beds than a “classic” hospital) is frankly threatened. The very economic vision of the DSAS, as expressed by the department’s head, focuses only on costs and does not talk about the services to be kept nearby or which will disappear in the remote areas of the canton. The right, Cynique, now criticizes the announcement of the Council of State Cups – where it is the majority, by the way -, which has called them for more than ten years.
Let’s be clear: without the pigs, the quality of the teaching of medicine will be affected and accessibility to care – therefore equity in the face of the disease – will be undermined. And it is an important part of the public health policy carried out for twenty years in the canton of Vaud which is attacked – by a socialist minister …
The debate is not closed. The political battle is launched against the backdrop of a reduction in taxes. Where is the search for the common good and social cohesion in this kind of decision – not to mention the chosen way and moment that give the impression that we do not want to listen to? And do not tell me that these cuts will be made without decrease in services.
Bernard Borel is a FMH pediatrician and municipal councilor in Aigle.