Beds in corridors, waiting patients, missing medicines. Anyone who walks into a Swiss hospital these days thinks they’re in a documentary about Britain’s ailing health care system or worse. It seems as if the Swiss healthcare system has become the patient himself.
Certainly, many of the problems are corona aftermath – from overworked staff to the higher susceptibility to viruses as a result of two years of hygiene measures. But the causes of the bottlenecks lie deeper and go back more than three Corona years. Several factors have contributed to the current emergency.
Self-inflicted staff shortage
Switzerland has no medical staff – and the problem is getting worse, according to a study by the management consultancy PWC: by 2040 there will be a shortage of nearly 45,000 healthcare workers, 39,500 nurses and 5,500 doctors.
Switzerland is trying to compensate for this, for example by expanding the number of study places for general practice, where the problem is particularly serious. Or with the upgrading of the nursing profession. That won’t be enough. Because we are getting older and need more medical care, as former canton doctor Thomas Steffen (61) says: “The staff shortage has been obvious for decades – you only had to look at the demographic development.”
Paul Sailer (32), director of Care Advice at PWC Switzerland, makes another hard diagnosis: the lack of doctors has been accepted by politicians. “Switzerland has in the past decided to import a lot of doctors instead of training all the necessary specialists itself.” Because they wanted to save on the cost of a medical degree – the most expensive degree there is. “The import strategy went well for a long time, but now seems to be reaching its limits.”
Health politician Ruth Humbel (65) is convinced that more money will not help. “Hospital bosses tell me that pay increases often lead nurses to shorten their hours,” she says. You cannot force people to fulfill higher positions. “But perhaps the amount of allowances or childcare allowance should be linked to the workload.”
Wrong incentives
The Swiss healthcare system is very complex – because 26 cantons are responsible, numerous lobbies are involved and even funding comes from various sources – premiums, taxpayers’ money and patients’ pockets. False incentives are inevitable. An example: the health insurers and the cantons share the costs for inpatient treatment in the hospital. However, the health insurers and thus the premium payers must pay the costs of the outpatient treatment – even if the treatment is in hospital.
Ruth Humbel has been campaigning for years for this to change: “Whether treatment is performed on an outpatient or inpatient basis should be a purely medical decision. But usually it’s not.” Instead of asking what’s better for the patient, ask what benefits you more. “It’s just more rewarding for a hospital to keep the people.”
No digital sense
Switzerland loves paper, but has little use for bits and bytes. Electronic Health Record (EHR) example: The system should have been running since 2012, but it still isn’t. And it went wrong, as Sailer says: “The original idea for the EHR was supposed to have increased treatment quality and efficiency. What we have now is the most expensive PDF collection in the world.”
True digitization could make many things more efficient. “One resident told me that when she sees a new patient, she spends half an afternoon calling doctors to get the history of the disease,” says Humbel. With a well-functioning EPD, this effort can be saved. According to the woman from Aargau, federal councilor Alain Berset (50) was never interested in the digitization of healthcare, “probably because you can’t get laurels there”. But she also makes hospitals, doctors and homes responsible: “You don’t always have to wait for politicians to optimize processes.”
Always costs, costs, costs
The Corona crisis has shown that we want high-quality care that is always available. Before the pandemic, only cost was discussed. Hospitals in particular have cut back on efficiency – with fixed rates per case and more competition. “There is a lot of cost pressure in the system,” says Steffen. In some cases, this has actually increased inappropriate care, Sailer says — because more interventions are being made that are rewarding. However, the result of the competition was not, as hoped, a streamlining of the structure. “Instead, unprofitable hospitals are sometimes kept alive by the cantons with cash injections or other privileges.” The most recent example of this is the canton hospital in Aarau, which had to be saved by the canton with 240 million Swiss francs.
Humbel advocates innovative approaches. Regional hospitals should be reorganized and become regional health centers – “with classic general practitioners, Spitex, geriatrics – and also get some more beds. In this way one could supply the population around and make better use of resources.”
We want everything and get too much
You can accuse politicians of many things, but part of the problem is homemade. Studies estimate that 10 to 20 percent of all procedures are unnecessary. “Compared to other countries, more orthopedic and cardiological procedures are performed in Switzerland,” management consultant Sailer cites two examples. You really don’t know why. “Here you could steer by paying more attention to the patient’s well-being – in other words, does an intervention really improve the patient’s quality of life?”
Humbel also wonders: “Regular checks or more and more checks in healthy babies: is that really always necessary?” She says that today there is a need for security that goes beyond common sense. This is also due to the increased expectations of the population.
Former cantonal doctor Steffen also sees the problem in the lack of prevention – Switzerland is doing poorly here in international comparison. “Don’t be surprised if trivial cases end up in emergencies,” he says. For many, the Swiss decentralized health system is a closed book: “Migrants in particular – and that can include British expats – don’t understand how things work here. We could do a lot more there.”
So many recipes for patient care. Whereby: He is not terminally ill. “The bottlenecks in the workforce differ greatly per region, specialty and hospital. While some are overwhelmed, others want more patients,” says Sailer. Better coordination would be desirable. With different levels of government, 26 cantons and countless lobbies, that’s not easy.