• Spending overview
• Policy overview
• Diseases overview

Spending overview

Switzerland spends a higher proportion of GDP on healthcare than any other country except the US, reflecting both a high standard of provision and fairly high fees, particularly for hospital treatment. Spending as a share of national income has risen over the past decade or so and is expected to continue to rise, reaching 11.6% of GDP by 2014. Meaningful measures to rein back spending further would require some kind of cuts in healthcare services or the fees for healthcare practitioners. In 2010 large premium increases are expected, which could create some political pressure for future reforms.

After the implementation of a major health reform in 1996, health insurance is mandatory in Switzerland, and everyone is individually insured, including children. Individuals are free to choose their insurer from a number of authorised operators, who cannot refuse to provide coverage. Those on low incomes and families with children receive a subsidy to their insurance contribution from the federal and cantonal governments. Tax revenue (federal, cantonal and local) constitutes another important source of healthcare financing, accounting for 25% of expenditure. Among other things, tax revenue is used to subsidise hospitals and nursing homes, as well as for insurance premiums for qualifying individuals. The public spending component is borne mainly by the cantons, which are charged with running public hospitals and other treatment centres—the federal government spending is mainly administrative, and municipalities also contribute little.

Policy overview

The Swiss healthcare system underwent major reform in 1996, when a premium-based system of compulsory basic health insurance was introduced. Satisfaction with the health system is generally high, and health indicators suggest that it works well.
Healthcare provision is a mixture of public, subsidised private and fully private. Most GPs are individual practitioners, paid on a fee-for-service basis by insurance companies. Hospitals may be publicly operated, for example by the cantons or local government, or private (either profitmaking or non-profitmaking). Fees are set by each canton. Patients are free to choose their providers, including specialists, among those recognised by the insurance system.

Despite efforts to reduce health insurance premiums, the fast growth in healthcare costs remains a major domestic political concern, meaning that further cost cutting in healthcare is likely to remain on the political agenda in the outlook period. The government has, however, struggled to implement change against a background of vested interests. Further progress on major reforms to healthcare is likely to remain slow, however, not least because public opposition to some of the measures is strong, so that it may be difficult to get the legislation approved in referendums. Trials are also under way for the diagnosis-related group (DRG) system of hospital financing. Under this system, hospitals get paid a sickness-specific fee, independent of the length of a patient's stay. It is hoped that this will reduce incentives for hospitals to keep patients longer than necessary.

Diseases overview

Apart from the cost pressures, the outcomes of the Swiss healthcare system are generally favourable. Life expectancy is quite high, at an estimated average of 80.8 years in 2009, and is expected to rise further. An indicator-based comparison with 17 European countries (EU15, Iceland and Norway) published by the Swiss Health Observatory (OBSAN) also shows that deaths caused by heart disease, strokes and similar diseases, and cancer are comparatively low. These mostly favourable results are related in no small part to the lifestyle, specifically the high level of health consciousness in Switzerland, but the high quality of the health system is undoubtedly an important factor too.

Nonetheless, in Switzerland there are signs of a rise in lifestyle-related illnesses, such as those related to obesity, which is on the rise, as in other affluent west European countries. The increasing popularity of convenience, ready-to-eat and takeaway meals, which often contain high salt and sugar levels, risks pushing up the incidence of diseases associated with a dietary imbalance. As average life expectancy rises, demand is also expected to increase for treatments for conditions related to old age, such as arthritis, rheumatism and diabetes. This is expected to increase the burden on the healthcare system, which is appropriating a steadily growing share of GDP.