JANUARY

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