Review calls for more efficient health system

Experts say more needs to be done to train professionals in general medicine at Swiss schools Keystone

Switzerland has made some progress towards a more efficient healthcare system, but further efforts are needed to reduce costs and increase transparency, experts say.

The federal health authorities on Monday acknowledged the joint report by the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO).

“It is a valuable guide for health policy and it shows that we are on the right track,” Pascal Strupler, head of the Federal Health Office, told a news conference.

He noted that the survey did not present any real surprises. “But it tells the truth with no holds barred.”

Strupler said Switzerland had to take seriously the recommendations, notably for improved data on health matters, increased prevention efforts, as well as better coordination between the various players in the health sector to improve quality.

“The report is not only a good point of reference for discussions in Switzerland but is also a good presentation of our health system,” he continued.

Stupler said the information provided served for more detailed discussions on issues such as health insurance, the provision of health personnel and the coordination between federal and cantonal authorities as well as other key players.

Some of the recommendations formulated by the WHO and OECD are in line with the health reforms underway in Switzerland, notably on prevention, the creation of a cancer register, the electronic patient record and managed care, Strupler said.

But he acknowledged that more needs to be done to improve governance and monitoring of the Swiss system to make the health policy more efficient.

“The aim is a better coordination of the strategies to face the challenges of chronic diseases and to set up national prevention programmes,” he said.

Good but costly

At the presentation of the report in Bern, John Martin, director for employment, labour and social affairs at the OECD, as well as Zsuzsanne Jakab, director of the WHO’s regional office for Europe, stressed that Switzerland’s excellent health system comes at a price.

Offering universal coverage and a very wide range of health services as well as granting patients a choice of health insurers, doctors and hospitals made it a costly system.

With 11.4 per cent of gross domestic product spent on health, Switzerland was well above the OECD average, as Martin pointed out.

He added that health costs were a heavy burden for many families.

“Overall effective premiums and out-of-pocket payments account for more than 20 per cent of a household’s disposable income for the bottom 20 per cent of residents,” Martin said.

He recommended building on the success of the managed care system to harness competition and to reduce the average stay in acute hospital care as well as to increase promotion of generic drugs as part of efforts to bring down costs.

Ageing population

Jakab added that people in Switzerland lived longer than almost anywhere else in the world as a result of their high standard of living and good health system.

“Demands on Switzerland’s health services will increase, as the burden of non -communicable diseases rises, Jakab warned.

She said that the hospital-centred health system will need to evolve to meet the challenges of an ageing population which face different chronic diseases.

The latest report is the second of its kind since 2006. The first survey had criticised high drugs prices and insufficient prevention and promotion work, as well as a lack of competition and the absence of a national health strategy.

Swiss health system

The Swiss health system cost SFr60.9 billion ($68.5 billion) in 2009 – making it the seventh most expensive in the world.

This represented 11.4% of Swiss Gross Domestic Product, nearly 2% above the OECD average.

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

Health review Switzerland

The report is the second of its kind by the OECD and WHO since 2006.

It was commissioned by the Swiss interior ministry.

The experts presented 26 policy recommendations for reform of the Swiss health system.

These include better information and improved strategic governance, as well as reforms of health financing and purchasing arrangements.

Changes to health personnel planning, strengthening prevention and healthcare quality, as well as increased efficiency of health care provision and pharmaceutical spending are also mooted in the report.