Health report proves bitter pill to swallow

Broken? The Swiss health system has recently come in for criticism Keystone

An international study citing serious shortcomings in the Swiss health system has earned a mixed response from observers at home.

While they agree with the report’s finding that services could be run more efficiently, they reject claims that the Swiss are not getting value for money.

A joint report by the Organisation for Economic Cooperation and Development (OECD) and the Geneva-based World Health Organization (WHO) states that health provision in Switzerland is in need of a major overhaul.

Complaints include high costs and drug prices, insufficient spending on prevention and promotion work, lack of competition and the absence of a coherent national strategy.

In an initial response, the Federal Health Office – which commissioned the 200-page report – said it agreed with the findings, pointing out that improvements were already underway.

On Thursday the Health Office announced that possible reforms could include higher taxes on cigarettes and alcohol and a comprehensive ban on their advertising. This, it was claimed, would tackle the imbalance between prevention and cure.

But Xavier Comtesse of the country’s leading think tank Avenir Suisse says the prognosis is excessively pessimistic.

He claims that rising demand for services, an ageing population and more expensive treatments mean higher costs are inevitable.

“Over the next 20 years the health system will cost more and more money, and I argue that people are OK with this,” he told swissinfo.

“The Swiss health system is one of the best worldwide and people are happy to pay for it – I have never seen a popular movement against the health system.”

Health policy

Sandro Cattacin, professor of sociology and health policy at the Swiss Graduate School of Public Administration, is also unconvinced.

“It’s true that costs in Switzerland are high, but at the same time we have a good health system,” he said. “People do get value for money.”

However, Comtesse and Cattacin agree that the issue of efficiency is a matter for concern. Comtesse says health services are too fragmented because of the 26 cantonal systems and there are too many hospitals and medical schools.

According to the Swiss Hospitals Association, there are 390 hospitals in Switzerland, including five university hospitals in Zurich, Basel, Bern, Lausanne and Geneva.

“We have to consider this as a regional problem and not as a cantonal one – the cantons are not able to create any more efficiencies,” said Comtesse.

Streamline services

Moves are already underway to tackle the issue but not everyone is in agreement. In July last year Zurich torpedoed an inter-cantonal accord to limit the number of hospitals offering cutting-edge medicine, including organ transplants, heart surgery, neurology and cardiology.

But some cantons are going ahead anyway. In May this year the cantonal health authorities of Bern and Basel said they would cooperate closely on heart surgery and set up a joint centre of competence. They are also seeking to coordinate neurosurgery between the two university clinics.

Geneva and Lausanne are also collaborating on high-cost surgery. All heart transplants now take place in Lausanne and liver transplants are done in Geneva, says Cattacin.

“The situation is very difficult in Switzerland at the moment. Some cantons are looking to strengthen their collaboration but Zurich is not convinced,” said Cornelia Oertle, deputy secretary-general of the conference of cantonal directors of health.

Cattacin, who is also head of sociology at Geneva University, favours increased coordination between health providers rather than more competition.

“I think that system coordination is in 2006 the only solution – not to diminishing costs, but to have a better way of managing the Swiss health system,” he said.

swissinfo, Adam Beaumont

In brief

Health policy is formulated at a federal level but Switzerland’s 26 cantons enjoy a high degree of autonomy in health matters.

An initiative in May 2003 backed by the centre-left Social Democratic Party pushing for changes to the mandatory health insurance system and other reforms was overwhelmingly rejected by voters.

The proposals called for many aspects of Swiss health policy, including “high-tech medicine”, to be administered at a federal rather than cantonal level.

Key facts

The Swiss health system cost SFr51.7 billion ($40.6 billion) in 2004.
This represents 11.5% of Swiss gross domestic product.
Only the United States spends more – 15% of GDP.
In 2003, drugs accounted for 10.5%, or SFr5.2 billion, of health costs in Switzerland.