This review of the Swiss health system was undertaken jointly by the OECD Secretariat and the World Health Organization (WHO) at the request of the Swiss Federal Office of Public Health. It follows the OECD reviews of the health systems of Korea (2003), Mexico (2005), Finland (2005) and Turkey (2008, in co-operation with the World Bank) and updates the first review of the Swiss health system, published in 2006.

This report reviews Switzerland’s health system. It provides an update to the information and analysis presented in the OECD Reviews of Health Systems: Switzerland published by the OECD and the WHO in 2006. In addition, it discusses three central policy issues for Swiss authorities: health insurance, the health workforce and governance of the Swiss health system. The report seeks to examine key aspects of Switzerland’s health system with a view to suggesting priorities for reform and providing insights from which other countries can learn.

People in Switzerland live longer than almost anywhere else in the world, supported by a high level of economic development and a responsive health system. Swiss residents benefit from their proximity to health services, a wide range of choice of providers and insurers, and broad coverage of essential medical and pharmaceutical services. The Swiss health system is among the best in the OECD. But this excellence comes at a price, with Switzerland spending 11.4% of GDP on health in 2009, well above the OECD average of 9.5% of GDP.

This chapter describes key features of Switzerland’s health system. With a small and ageing population, Switzerland enjoys some of the best health outcomes amongst OECD countries, albeit at greater cost than most others. Health care is a major contributor to the Swiss economy. The central feature of the Swiss health system is its mandatory health insurance, provided through regulated competition between insurers. Mandatory health insurance supports Swiss citizens for the full spectrum of their basic health needs, from ambulatory care through to hospital care. Cantons play a significant role in financing, organising and delivering health care services.

This chapter examines the health insurance system of Switzerland. Section 2.1 outlines the general trends in Switzerland’s health insurance market, including the role of private supplementary health insurance. Section 2.2 discusses health financing equity issues and the financial burden faced by households by assessing premium level differences, the premium subsidy mechanism and out-of-pocket payments. In Section 2.3, the extent of competition in the health insurance market is discussed, with a focus on the risk equalisation mechanism and managed care plans. Finally, Section 2.4 reviews the current reform agenda and examines proposals on the surveillance of the insurance market and the development of integrated care networks.

This chapter examines the health workforce in Switzerland. Section 3.1 provides an overview of the health workforce in Switzerland in terms of distribution and evolution. It also discusses the forecasted health workforce shortage. In Section 3.2, trends shaping the health workforce are reviewed and health workforce ageing, feminisation of the medical profession, as well as the expectations of younger generations of doctors in terms of professional and private life balance are all discussed. In Section 3.3, the recent reforms in the field of education are briefly reviewed and their implications are discussed. This section also examines whether or not Switzerland is training enough health personnel. The issue of international health worker migration is addressed in Section 3.4, and policies aiming to ensure better use of the existing health workforce are presented in Section 3.5. Finally, the major challenges to addressing health workforce issues in Switzerland are discussed in Section 3.6.

This chapter examines recent progress on public health and prevention, quality of care, hospital financing and pharmaceuticals. Despite some encouraging developments in recent years, public health and health promotion in Switzerland remains largely uncoordinated and varies in line with cantonal policies and capacities. As debate has continued over a new prevention law, progress has been slow in promoting cost-effective health prevention policies or expanding coverage of successful prevention measures – such as breast cancer screening. Similarly, while recent efforts to expand collection of quality of care data are worthwhile, there remains a need for nationally consistent data collection to determine whether Swiss people are indeed receiving best practice health care. Switzerland’s move to a casebased financing of inpatient hospital services is a positive move that should help improve efficiency. The extent to which it does so will critically depend on how individual cantons implement these reforms. Pharmaceutical policies have met some success, though more could be done to increase value for money.

This chapter describes the governance of Switzerland’s health system and the reform process. Governance in Switzerland is founded on decentralised approaches and consensus seeking. This can often curb the political capacity for reform, but it also provides opportunities for innovative policies at a municipal or cantonal level for sharing knowledge and best practices. In this context, improving governance will depend on the ability of the Swiss authorities and other stakeholders to develop and implement a strategic vision for the future of the Swiss health system. The ongoing discussions over a potential law on prevention and the national health strategy project are important initiatives in this direction. Better governance will also require development of nationwide information systems and generating better evidence to inform policy.