Issue: June 2013
June 01, 2013
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Swiss health care system faces challenges in sustaining high standards

Issue: June 2013
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With an investment of 11.5% of its gross domestic product on health, Switzerland figures among the top countries of Organisation for Economic Co-operation and Development for medical expenditure. Its health care system, public and private, is renowned in Europe for quality and efficiency. However, it has been affected by the global economic downturn and eurozone crisis.

“Europe is our main trading partner, traditionally purchasing at least half of our exports. The current crisis has stalled export demand and put us in an interesting situation,” Tarek M. Shaarawy, MD, MSc, director of the glaucoma sector at the University Hospital of Geneva, said.

Two years ago, when the Swiss franc increased in value, the government and the Swiss Central Bank intervened in the currency market, establishing a fixed rate of 1:1.2 for the euro-franc exchange. This provision stopped the uncontrolled increase of the Swiss currency.

“This means that we can still have our services provided at a reasonable rate,” Shaarawy said.

Although not a member of the European Union, Switzerland is part of the Schengen zone of borderless free movement of goods and people. Geographically and historically, it is part of Europe; therefore, whatever affects Europe affects Switzerland.

“We could not escape the domino effect of the crisis, and the domino effect of the crisis has rapidly involved health care,” Shaarawy said.

Reducing costs

In ophthalmology, the public sector is currently losing space and personnel, and it is under pressure to reduce costs. The private sector, on the other hand, is burdened by time-consuming procedures for obtaining authorizations to new treatments and investigations.

“This comes at a time when new treatment options, with new molecules and cutting-edge technology, are exploding in ophthalmology. The demand is growing and costs are higher than they have ever been. Containing them, and preserving quality at the same time, is the challenge we are facing at the moment,” Shaarawy said.

 In the everyday battle to maintain its traditionally high standards of care despite the diminishing resources, Swiss ophthalmology is finding its way by trial and error, he said.

However, the high civic sense of the Swiss society is likely to continue driving stakeholders toward the development of successful strategies in favor of the patients. In 2011, the Ministry of Health negotiated with Novartis a drop of 30% in the price of the anti-VEGF drug Lucentis (ranibizumab, Novartis/Genentech). Should the nationwide sales of the drug exceed 100 million francs, the price of the drug might drop even further.

Report card: Switzerland

 

“There are multiple players involved — the central government, local authorities, hospital administrators, doctors, public and private — who are the voice of protest against health budget cuts. Medical societies are constantly watching that quality is not lost, and the patient organizations are gaining voice. Being united toward common goals has always been our strength. The risk, in this difficult situation of economic downturn, is that we lose trust in each other and lose solidarity,” Shaarawy said.

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Health is a priority, he said, and at a time of diminishing resources, it must remain clear that health is where those resources should be primarily allocated.

Unique health care mode

Switzerland has a unique model of compulsory, universal health care that is not state-funded but managed by private, nonprofit insurance companies. Every Swiss resident is required to purchase basic health insurance, and only in specific situations are individuals who are unable to buy insurance covered by a social security fund.

“There are multiple insurance companies, but all of them offer similar conditions. We are graded for access to services according to two basic terms of the insurance contract. First is the excess, ranging between 1,000 and 2,000 Swiss francs. The higher the excess, the lower the amount we pay monthly to the insurance. Second is the option we choose in case of hospitalization. Different insurance plans at different costs are offered for being hospitalized in a ward; in a semi-private wing, where we share the room with no more than one person; or in a private, single room. Of course the insurance premium varies accordingly,” Shaarawy said.

Whatever the insurance plan, patients are guaranteed equally high standards of treatment, he said.

Procedures that are not covered and require out-of-pocket payment are refractive and cosmetic surgery. Coverage for premium lenses depends on the individual insurance plan, but some of the less expensive premium IOLs are offered also with standard cataract procedures in public hospitals.

Providers of care

“Most emergency treatments are provided in public hospitals, but for primary care ophthalmology and for outpatient surgical procedures like cataract, private practices are in the forefront,” Shaarawy said.

The needs of the population are well covered, with a ratio of 99 ophthalmologists per 1 million people.

The ophthalmologists who work in private practices of various sizes, from small ambulatory practices to tertiary care hospitals providing highly specialized treatment, are the majority.

Due to a long reputation of quality and efficiency, Swiss private clinics and large public hospitals attract a high number of international patients.

“In Geneva, we have a high percentage of foreign patients, thanks also to the presence of [United Nations] offices and of a busy international airport. But medical tourism has a long tradition in our clinics all over the country, dating back at least 100 years,” Shaarawy said.

There are five university hospitals in Switzerland, located in the five largest cities: Geneva, Lausanne, Zurich, Basel and Bern.

As an academic and clinical senior staff member at one of these institutions, Shaarawy thinks that the balance between clinical practice, education and research is even more delicate in the present times.

“We are constricted by the lack of personnel and shortage of funds, and yet we have the responsibility to prepare a new generation of professionals able to manage the challenges of the increasing age of the population, the overwhelming technological advances and the high expectations of patients against the reality of diminishing resources,” he said.

Research, which is a vital part of universities, is squeezed under the pressure of administration, the lack of personnel and the economic crisis of Europe.

“Access to research grants is dwindling, and doing research in an academic milieu requires a high level of creativity, imagination and insight for innovation,” Shaarawy said. – by Michela Cimberle

Disclosure: Shaarawy has no relevant financial disclosures.