Table of Contents

  • The Swiss health system meets a range of important goals set for it. Measures of health status compare well with other OECD countries. It has achieved universal health-insurance coverage, permitting access to a broad range of health-care services. Up-to-date medical services are widely available and patients are largely satisfied with the health services they receive. However, these successes come at a high financial cost. Spending on health as a share of GDP (or GNP) is among the highest in the OECD area, and continues to increase more rapidly than GDP. At the same time, other OECD countries perform equally well, or even better, at lower levels of health spending.

  • This chapter describes the key characteristics of the Swiss health system. It identifies the main actors operating within the system and highlights their roles and relationships. Section 1.1 provides some background on salient features of Switzerland, its administrative/political structure, the characteristics of the population, and the social environment. Section 1.2 provides a brief overview of the size of the health system, and its importance within the Swiss economy. Next, in Section 1.3, the chapter focuses on governance, and the sharing of responsibilities for health policy development, and for implementation and provision. Section 1.4 explains arrangements for the financing of the health system, as well as those for the insurance coverage of the population. This is followed, in Section 1.5, by a description of the organisation of health service delivery and the relationship between providers and patients. A final section explains payment and contractual arrangements between providers and third-party payers.

  • This chapter examines how the Swiss health system performs in terms of health achievements, prevention, and quality of health services. While the Swiss health system is relatively expensive, it delivers high health outcomes and inequalities in health are less pronounced than in most other OECD countries. However, in the field of health promotion and disease prevention, outcomes are mixed and opportunities to improve health are not currently being taken. A lack of clear designation of responsibilities in the Swiss system and incentives to invest in prevention activities are key reasons for this. Finally, while quality is recognised as an important issue, mechanisms for monitoring and managing health-care quality seem weak and make it difficult to have an overall view of the quality of the Swiss health-care system.

  • This chapter examines the strengths and weaknesses of the Swiss health system with regard to two main objectives of health-system performance: achieving equitable coverage for and access to health care; and ensuring responsiveness to patient needs. The chapter outlines the key challenges and achievements, examining possible reasons underlying current performance. It also discusses some of the key policies that the authorities have implemented to improve performance.

  • This chapter first examines factors underlying the rapid increase in spending and possible future trends if current arrangements for supply, demand and governance remain unchanged. Section 4.1 also examines some of the reasons for the relatively high level of health spending in Switzerland. Identifying these factors may suggest areas where efficiency gains and improved value for money could be achieved (Section 4.2). These could help offset the impact of rising demand for health on the costs of the health system.

  • While the LAMal’s goals of access and insurance coverage have been broadly achieved, health-system costs continue to rise more rapidly than GDP, creating pressures on the ability of the system to finance the growth in outlays. This has led the Swiss authorities to consider further ways to improve the cost performance of the system, again within the framework of the federal Health-insurance Law. Since 1996, different revisions to the LAMal have been discussed by parliament, the latest of which is ongoing. This chapter described these revisions and their current legislative status.

  • This chapter provides a broad assessment of the performance of the Swiss health system, drawing on the analysis presented in preceding chapters. It highlights key challenges facing policy makers, as well as constraints on the implementation of these changes. It also makes policy recommendations for improving the Swiss health system, in both the short and the longer-term future.