Temporary nursing is expensive – but the bill only starts there
Staff leasing costs hospitals more than a permanent position. Whether it makes no economic sense, however, depends on which gap it fills and what would happen without it.
The federal expert opinion notes that the costs of staff placed and leased are higher than those of permanent employees. For the scale of the extra costs, however, it points to differing assessments. A Switzerland-wide uniform difference per hour worked cannot be derived from it.
That matters for premium payers, cantons and hospitals. The point is not to gloss over agency work. The point is the right question: is it a rare safeguard for short-notice absences – or does it permanently replace posts that an organisation cannot fill or hold?
Temporary does not mean fixed-term
The Swiss Health Observatory (Obsan) separates two models. In private job placement, job seekers and employers find each other. In staff leasing, by contrast, the nursing professional is paid by the lessor and works at the host organisation. Colloquially both are often called «temporary», but legally and economically they are not the same.
An in-house pool is likewise not staff leasing, provided the nursing professionals are employed directly by the institution. Anyone who puts all fixed-term assignments or internal float pools into the same cost category is comparing different models. For staff leasing, Obsan measures only people who found their job through an agency and are paid by it.
The national statistics are also not a complete account of all Swiss healthcare institutions. They are based on the Swiss Labour Force Survey and cover the permanent resident population. Cross-border commuters and short-stay residents are missing. Obsan therefore itself warns against inferring the full extent of staff leasing from the indicator – especially in border regions.
Extra costs are documented, but their level is not standardised
The finding of the federal expert opinion is sufficient for a serious debate: placed and leased nursing staff cost more than permanent employees. What remains open is how large the gap actually is at a given hospital. Contracts, qualifications, assignment duration, night and weekend shifts as well as regional labour markets differ. Deriving a national flat rate from individual invoices or industry figures would therefore not be robust.
The extra costs are nevertheless relevant. If external assignments become the norm over months, they can make staffing budgets harder to plan. At the same time, not every high invoice is proof of poor management. Obsan notes that if qualified staff are lacking, the workload of the remaining team rises or the service must be reduced; both can impair the quality of care. In an acute gap, an external assignment can therefore secure care that would otherwise come under pressure.
A fair calculation needs a comparison
How economical an assignment is cannot be answered by the hourly rate alone. A hospital should compare transparently: how much does the leasing contract cost? What alternative actually existed? Which additional shifts, absences or reductions in services would probably have occurred without a replacement? These questions provide no automatic justification. But they prevent a short-term stopgap from being confused with a structural problem.
The perspective of nursing staff is equally important. The federal expert opinion describes internal and external pools as possible instruments against overburdening permanent staff. It also points out, however, that changing workplaces, teams and irregular assignment times can be a strain for pool nursing professionals. Anyone who looks only at the agency invoice overlooks both the protection of the core team and the risks for the professionals deployed.
The right conclusion is not a general ban. A flexible pool can make sense for illness, holidays, seasonal pressures or unexpected events. It becomes a warning signal when a hospital remains regularly dependent on external staff because rosters, development opportunities or attachment to the profession do not hold up.
Why this affects premium payers
For inpatient services at listed hospitals, the cantons today finance at least 55 percent of the costs; at most 45 percent is covered by premiums. Higher personnel costs therefore do not appear one-to-one on the next premium invoice. But they burden hospital budgets as well as public households and insurance financing. From 2028, uniform financing of outpatient and inpatient services is due to take effect; the incentives and money flows will change once again.
For the average Swiss resident, transparency therefore matters more than a spectacular figure. Hospitals should be able to show internally and to their governing bodies how many hours they cover through staff leasing, which functions are affected, how long the assignments last and what costs stand against them. That is a journalistically justified demand for steering knowledge, not a nationally standardised indicator prescribed today.
Flexibility as a reserve, not a permanent solution
The nursing initiative and its implementation focus not only on training places but also on working conditions and career development. That fits the cost question: anyone who keeps professionals in the profession and organises internal reserves sensibly reduces dependence on short-term stopgaps without making them impossible.
Temporary work is therefore neither inherently wasteful nor proof of secure care. It is more expensive than a permanent position, but the concrete calculation depends on the assignment. Good hospital management recognises the difference – and explains it openly before an exceptional instrument becomes a permanent business model.
Sources
- Obsan: Job placement and staff leasing in nursing and care
- BAG/ZHAW: Expert opinion on the labour law situation of nursing staff
- Obsan: Advertised positions for nursing and care staff
- BAG: Implementation of the nursing initiative (Art. 117b of the Federal Constitution)
- BAG: Uniform financing of services
