IFM allocationmodel for support services in hospitals as a basis for FM driven financing of healthcare real estate

Switzerland is among the top ranked countries in terms of health expenditure as a percentage of its GDP. Since 2012, Swiss hospitals have had to comply with Diagnosis Related Groups (DRG) and thus have to be more cost oriented. Nevertheless, large investments will be necessary to replace aging hospital infrastructure (so far investments have been financed by the government, this has now been changed to a self-financing model). Two peculiarities of the Swiss hospital market are that the operators of a hospital are often the owners of the infrastructure and the providers of the services. Austerity and stronger competition are likely to lead to cost related changes, most probably resulting in a need for hospitals to be financed in new ways (such as PPP, subsidiaries or joint ventures models). Due to the low quality of the available data and inconsistent use of FM terms, an allocation system is required prior to any investigation into new ways of financing healthcare infrastructure. In order to systematically develop FM services in hospitals, the “Allocation Model for Support Services in Hospitals” has been developed. It is mainly based on the EN 15221-4 European/Swiss norm, but also includes a to date unavailable specification for hospital contexts and their specific accounting directives. Two possibilities for new FM driven financing concepts in Swiss hospitals resulted from this piece of research: an External Supplier Concept and a Private Finance Initiative.