Healthcare costs are rising and rising – we are also responsible for that

The shortage of skilled labor in Switzerland has reached an all-time high. This was recently announced by recruiter Adecco. The healthcare sector is particularly hard hit. There are still not enough skilled workers being trained here and the working conditions are “challenging”, according to Adecco.

However, there is another factor fueling the shortage of skilled labour: Switzerland’s health care system is growing rapidly. The Federal Bureau of Statistics has just published new figures for hospitals: last year they employed more than 230,000 people, sharing nearly 180,000 full-time jobs. That is an increase of 12.8 percent in seven years.

With an increase of 20 percent each, hospital doctors and administration are among the areas that have grown the most. For nursing staff, the increase was 8.5 percent lower in the same period.

It is clear that more staff is needed for medical care: the population is growing, people are getting older. But that alone cannot explain the explosive growth in health care: While Switzerland’s population increased by about 4 percent between 2015 and 2020, health care costs rose by 12 percent.

The health economist Stefan Felder of the University of Basel explains the discrepancy with our prosperity: Due to rising incomes, the health sector has grown disproportionately. With increasing prosperity, classic consumer goods such as housing, clothing or means of transport become saturated, with additional consumption shifting to the health sector. “In Switzerland, there is a high willingness to pay for health,” says Felder.

As examples, he cites the high demand in the fitness and beauty sector, but also preventive treatments such as breast cancer screening. According to Felder, they do more harm than good. Because: Side effects with early detection are mainly overdiagnoses. This means that benign changes are wrongly classified as harmful and the woman is consequently treated as a cancer patient. However, this attitude is controversial among experts. The Cancer League writes that the benefits of mammography screening programs today outweigh the drawbacks.

The development is apparently fueled by another factor: the insurance coverage means there are no financial incentives to use fewer services. Felder locates the problem in the basic insurance, which he believes covers too many benefits. “Our compulsory health insurance offers an incredible total package for everyone,” says the economist.

The number of treatments performed is impressive: the number of outpatient consultations has increased by 34 percent since 2015 and now exceeds 24 million. Inpatient cases increased by 2.4 percent. The shift from inpatient to outpatient is politically desirable in order to save costs.

While other industries have been able to produce more in the same amount of time thanks to automation, healthcare has remained labour-intensive. Doing research, taking care of patients, people continue to do all this, but they cannot be optimized like a machine. At the same time, according to the Association of Swiss Assistant and Senior Physicians (VSAO), the working hours of medical staff are decreasing. So more staff is needed to provide the same services.

“This development is justified and necessary, as doctors are no longer willing to work 80 hours or more per week,” says Philipp Thüler of the VSAO. With an average of 56 hours per week, the workload of hospital doctors is still much too high and ultimately illegal. The association therefore demands a working week of 42 hours of patient care and 4 hours of structured further training.

Because Switzerland itself trains too few skilled workers, it has increasingly called on foreign personnel in recent years.

This is particularly pronounced among hospital doctors: 70 percent of the newly created full-time equivalents since 2010 are employed by foreign doctors. The share of hospital doctors with a Swiss passport fell from 60 to 51.5 percent.

In recent years, politicians have hardly made any breakthroughs in the field of training financing and cost reduction. Felder advocates higher deductibles so that people need fewer treatments. But the catalog of services in the basic insurance also needs to be cleaned up. More private supplementary insurance is again needed, the importance of which has declined in recent years.

This would mean that insured persons would increasingly have to bear healthcare costs themselves.

The SP wants to go the other way. According to a party position, the goal should be to maintain and expand basic services across the country with access for all. It is not the wallet that should determine who can use which care. The Social Democrats would like to finance such a system through a public health insurance company with means-tested contributions. (aargauerzeitung.ch)