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SWITZERLAND Organization of the Health System in Switzerland Swiss Federal Council Cantonal Governments Communal Governments Federal Department of Home Affairs Federal Department of Financial Affairs Cantonal Ministries of Public Health: Health Services, Health Safety, Health Prevention and Promotion Communal Departments of Public Health Federal Office of Public Health FOPH Swiss Agency for Therapeutic Products swissmedic Swiss Financial Market Supervisory Authority FINMA Swiss Conference of Cantonal Health Ministers Central Secretariat National Associations of Swiss Health Insurance Companies Cantonal or Regional Associations Health Insurance Companies Statutory Health Insurance Voluntary Health Insurance Corporation SwissDRG AG Institution: National Service Scale TARMEDsuisse Association of Swiss Hospitals H+ Cantonal Hospital Associations Swiss Private Hospitals Association Cantonal Associations of Private Hospitals Swiss Association of Homes and Institutions Cantonal Nursing Home Associations Swiss Medical Association FMH Cantonal Medical Associations Swiss Spitex Association Cantonal Spitex Associations Swiss Pharmacies Association Cantonal Pharm. Associations Other Outpatient Providers Cantonal Associations of Other Providers Public and Publicly Subsidized Hospitals Private Hospitals Public and Publicly Subsidized Nursing Homes Private Nursing Homes Private Practitioners Public and Publicly Subsidized Spitex Organizations Private Spitex Organizations Pharmacies and Retailers for Medical Devices Physiotherapy, Psychotherapy, Laboratory, etc. Source: P. Camenzind, Swiss Health Observatory, 2015. What is being done to reduce disparities? There are several reasons why health disparities have not attracted as much political and professional interest at the national level as elsewhere: Health inequalities are not considered to be very significant in comparison to other OECD countries; it is difficult to obtain detailed statistical information about the epidemiology of health outcomes; and health inequalities are seen more as the responsibility of cantons, making them less visible at the national level. The Swiss Federal Council’s national Health2020 agenda (FDHA, 2013) includes the explicit objective of improving the health opportunities of the most vulnerable population groups, such as children and the young, those on low incomes or with a poor educational background, the elderly, and immigrants. The aim is to prevent vulnerable population groups from being unable to make appropriate use of necessary health care services. Health and health access variations are measured and reported publicly by the Swiss Health Survey (SFOS, 2014) every five years. What is being done to promote delivery system integration and care coordination? Care coordination is an issue, particularly in light of a projected lack of providers in the future and the need to improve efficiency to increase capacity. The task force Dialogue on National Health Policy discusses existing and 166 The Commonwealth Fund
SWITZERLAND new approaches to care. The national Health2020 agenda includes a comprehensive projection of the priorities of health care policy until the year 2020. The agenda also addresses care coordination, stating that integrated health care models need to be supported in all areas. The FOPH works on concrete measures to confront these challenges. Strategies and networks tackling emerging areas of importance, like palliative care, dementia, and mental health, have been created to improve coordination. They start on a conceptual level, aiming at the practical level to encourage different types of health professionals to work together. A growing number of such programs are in the works, as shown in the National Health Report (Obsan, 2015), but pooled funding streams do not exist yet. It is also worth noting the efforts in the area of e-health (see below), which should considerably improve coordination as well. What is the status of electronic health records? A national e-health service called eHealth Suisse (an administrative unit of the FOPH) is coordinated by the federal and cantonal governments and has three sets of responsibilities. First, all providers in Switzerland should be able to collect and store information on their patients’ treatment electronically. Second, health-related websites and online services will be required to undergo quality certification and a national health website will be constructed. Third, necessary legal changes will be made to realize these measures. A key element of eHealth Suisse is the SHI subscription card, which encodes a personal identification number and all necessary administrative data. If allowed by the insured person, information about allergies, illnesses, and medication can be recorded on the card. The insured person also decides who is allowed access to this information (all, selected, or no providers). GP e-health is still at an early stage (Vilpert, 2012), and there are ongoing discussions about incentives for physicians to adopt new technologies. Hospitals are generally more advanced; some have merged their internal clinical systems in recent years and hold interdisciplinary patient files. However, the extent of this integration varies greatly among hospitals and among cantons, despite efforts by eHealth Suisse to convince providers of the benefits of electronic health records for medical practice. An interoperable national patient record is not a priority for eHealth Suisse, since the principles of decentralization, privacy, and data protection are regarded as very important. How are costs contained? Switzerland’s health care costs are among the highest in the world. “Regulated competition” (Enthoven, 1993) among nonprofit health insurers and among service providers is aimed at containing costs and guaranteeing high-quality health care, and establishing solidarity among the insured. While most of its objectives are considered successfully achieved, academic analyses (OECD, 2011) and public perception have been critical of competition’s ability to control health care costs. A global budget, however, has never been regarded as a possible remedy for this problem. Failures are ascribed largely to inadequate risk equalization, the dual funding of hospitals, and pressure on insurers to contract with all certified providers (OECD, 2011). The costs of providing mandatory benefits in the health system could be reduced by up to 20 percent (FDHA, 2013). An overview of possible cost-reducing measures—in coordination of care, compensating systems, and highly specialized medicine—is part of the Health2020 agenda. The agenda outlines a need for increasing flat-rate remuneration mechanisms and revising existing fee schedules to limit incentives for service providers. Also mentioned is the need for greater concentration in sites of highly specialized medicine to eliminate inefficiency and duplication in infrastructure systems and to increase the quality of health care provision. SwissDRG AG was introduced to contain hospital costs. Inpatient capacity is subject to cantonal planning requirements, and there is a “necessity clause for outpatient providers.” See also the section on cost-sharing for patient cost-sharing mechanisms. International Profiles of Health Care Systems, 2015 167
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JANUARY 2016 2015 International Pro
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2015 International Profiles of Heal
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Table 1. Health Care System Financi
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Table 3. Selected Health System Per
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The Australian Health Care System,
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AUSTRALIA low-income adults, childr
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AUSTRALIA In 2013, the federal gove
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What is being done to reduce dispar
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References AUSTRALIA Australian Bur
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CANADA What is covered? Services: T
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CANADA funding to 145 not-for-profi
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CANADA Organization of the Health S
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CANADA provides recommendations to
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CANADA Health Council of Canada (20
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CHINA Private health insurance: Com
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CHINA is not substantially more exp
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CHINA Organization of the Health Sy
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CHINA References Chen, X. (2014).
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DENMARK In addition, nearly 1.5 mil
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DENMARK Social psychiatry and care
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DENMARK Quality data for a number o
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DENMARK portion is small, it makes
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ENGLAND immunization, and vaccinati
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ENGLAND Hospitals: Publicly owned h
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ENGLAND Organization of the Health
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ENGLAND How are costs contained? Ra
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ENGLAND Organisation for Economic C
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FRANCE VHI finances 13.8 percent of
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FRANCE The average income of primar
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FRANCE What are the key entities fo
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FRANCE inequities in prevention rel
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FRANCE Nolte, E., C. Knai, and M. M
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GERMANY There were 42 substitutive
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GERMANY The 16 state governments de
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GERMANY management system, by the s
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GERMANY What major innovations and
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INDIA Private health insurance: The
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INDIA provide after-hour care, reim
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INDIA are provided by other ministr
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INDIA How are costs contained? Ther
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ISRAEL Together, these two types of
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ISRAEL Primary care physicians are
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ISRAEL Organization of the Health S
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ISRAEL • Using electronic health
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ITALY during hospitalization (Thoms
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ITALY Some regions are promoting ca
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ITALY Organization of the Health Sy
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ITALY although the degree of evolut
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ITALY The author would like to ackn
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JAPAN What is covered? Services: Al
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JAPAN incentives for providers to c
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JAPAN Organization of the Health Sy
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JAPAN The author would like to ackn
Page 116 and 117: THE NETHERLANDS receive faster acce
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Page 134 and 135: NORWAY Primary, preventive, and nur
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Page 140 and 141: NORWAY The National System for the
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Page 144 and 145: SINGAPORE Medifund is the governmen
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Page 154 and 155: SWEDEN What is covered? Services: T
Page 156 and 157: SWEDEN Hospitals: There are seven u
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Page 162 and 163: SWITZERLAND Insurers offer premiums
Page 164 and 165: SWITZERLAND Hospitals: About 70 per
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Page 172 and 173: UNITED STATES What is covered? Serv
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