The Swiss health care system is according to an analysis by the OECD and WHO one on the worlds best. At the same time it is also too expensive, inefficient and not transparent.
Health spending in Switzerland for the year 2009 were at 11.4 percent of gross domestic product. Only six OECD countries had a higher percentage. Figure 1 shows that in several areas of health care Switzerland is performing under the OECD average. Among the 26 recommendations for reform that are listed in the report are therefore numerous proposals for cost reduction and efficiency increase.
Figure: Efficiency and Quality. Comparison between Switzerland, the OECD and Group 1 (Germany, Netherlands, Slovak Republic, Switzerland), Source: OECD
The report suggests for example, to allow freedom of contract between insurers and providers gradually. Although the population could choose from a large number of health insurance providers today, the health insurance premiums competition between providers is still very limited. That can be seen through the small number of policyholders who would opt for a change of the insurance company.
While OECD countries spend an average of 3.1 percent of their health care expenditures for prevention, in Switzerland only 2.3 percent of expenditures flowed in prevention in 2008. Even more important is the prevention law, which is currently in discussion by the parliament and should reach a higher commitment by the federal government in the upcoming years.
In the analysis it is stated that the introduction of performance-related packages, in Switzerland called managed care model, is an essential step to increase efficiency. The managed care model was approved by parliament in the autumn session, but the medical profession has announced a referendum. This means that the Swiss population will be asked directly to either accept or reject the proposel of the managed care model. According to the report by the OECD and WHO it could improve doctors quality, efficiency and coordination of care. The proposal envisages that those who continue to insist on the free choice of doctor, have to come up a higher deductible. Among the recommendations within the report the introduction of an electronic patient file is listed. A corresponding topic is currently in consultation within the parliament.
The efforts to solve the problem of low efficiency and high costs are going according to the experts from OECD and WHO not far enough. The report warns, in order to meet future challenges today’s Swiss health system has to be adapted and more optimized. There is going to be a higher burden for the health care system because of the increasing number of chronic diseases. Obesity, for example, is still not widespread, but is steadily increasing.
OECD and WHO already examined the Swiss health care system carefully in 2006. The criticism in the second analysis is still similar to the first – also in the previous report the high cost and the lack of efficiency were denounced. It is stated in the analysis that the consensus of the democratic political system of Switzerland built delays in the reform efforts and have resulted in insufficient progress dealing with the problematic issues.
In the opinion of the author there should be a strategic long-term change of the Swiss health care system in order to enhance the health of population, avoid unnecessary treatments and complications. But also heighten existing reserves through higher efficiency and transparent structures as well as better regulation of the system – therefore the managed care model would be a good approach to tackle some of the problems.