Management report - Political environment
In autumn 2022, the KOF Swiss Economic Institute at the Federal Institute of Technology of Zurich (ETH Zurich) is forecasting growth in healthcare spending of 2.9% in 2022 and of 3.1% in 2023. The effects of the COVID-19 pandemic were felt directly until mid-2022 – due to postponed treatments and possible long-term consequences of the pandemic, KOF also predicts continued growth for 2023. Healthcare expenditure as a percentage of GDP is declining slightly.
Number of employees in the Swiss healthcare sector
Full-time equivalents (2021, source: Federal Statistical Office)
Measures to contain increases in health insurance premiums
The average premiums of health insurance funds will increase by 6.6% in 2023. This is primarily due to the Federal Council’s forced release of the reserves held by health insurance funds and the effects of the COVID-19 pandemic, which have both placed considerable strain on the healthcare system. The average increase in health insurance premiums has been 1.5% since 2018, compared with 3.5% in the years 2013 to 2018. The Federal Council continues to regard the containment of healthcare costs as a top priority.
Due to the high premium burden, the Social Democratic Party (SP) of Switzerland has launched the federal popular initiative entitled “Maximum of 10% of income for health insurance premiums (premium relief initiative)”. Parliament has drawn up an indirect counterproposal, with the Councils aiming to adjust for differences via the amount set for premium reductions.
The party known as the Centre (formerly the Christian Democratic People’s Party CVP) has submitted the federal popular initiative “For lower premiums – cost brake in the healthcare system (cost brake initiative)”. An indirect counter-proposal is also being discussed in relation to this proposal. The National Council wants to strengthen the powers of the licensing authority in case the parties to collective bargaining arrangements are unable to reach an agreement during contract negotiations. A collective agreement should also enter into force if the partners have reached an agreement, but the licensing authority does not make a decision within a given period of time. If the new regulation had already been in force, the Tardoc medical tariff, for example, would probably have entered into force already.
First package of measures to contain healthcare costs now agreed
Parliament has divided the first package of measures to contain healthcare costs into two packages. The first part, which comprises less controversial measures, was adopted by parliament back in 2021.
In the second package, parliament voted against direct imports of medicinal products and against a reference price system for the reimbursement of medicinal products. These measures were contested by many associations in the healthcare sector. They feared that patient safety would suffer and that the supply of medicinal products could deteriorate further. Both Councils decided to simplify the approval of parallel-imported medicinal products. They also agreed on the right of health insurance associations to appeal against cantonal hospital planning decisions.
Parties to collective bargaining arrangements are obliged to monitor costs in their areas and to take corrective measures in the event of an unexplained increase in costs. However, following extensive deliberation, parliament decided against giving cantons opportunities to intervene if the parties to collective bargaining arrangements fail to reach an agreement.
Parliament expects the so-called "experimental article", which entered into force on 1 January 2023, to have cost-saving effects. This enables the testing of innovative and cost-saving pilot projects to ease the burden on premium payers that deviate from previous statutory regulations.
The pilot projects are limited in terms of content, time and location and must be approved by the Federal Department of Home Affairs (FDHA). Pilot projects that have proved their worth during the test phase are included in the scope of the Health Insurance Act (HIA) and can be provided without a prescription from a doctor. For example, direct access to selected services that, under the law as it applies, are only possible with a doctor’s prescription.
Pharmacies in Switzerland
(2022, source: Pharmasuisse)
The second package of cost containment measures is having a difficult time
On 7 September 2022, the Federal Council passed a second package of cost containment measures for the attention of parliament. With this package of measures, the Federal Council is pursuing three objectives: it wants to reduce any increase in volume that is not medically justified, curb the rising costs of basic health insurance and improve the quality of healthcare provision. The approach proposed by the Federal Council met with great opposition from stakeholders. This was despite the fact that the Federal Council had deleted key elements from the proposal that were criticised during the consultation process. For example, the idea of having an initial medical point of contact is being dropped.
The second package of cost containment measures contains the following elements (selection):
- Networks for coordinated care
All associations agree with the great importance of networks for coordinated care but reject the Federal Council’s proposal. Among other things, there is criticism that the networks are becoming independent service providers who bill the insured persons for services. The National Council Social Security and Health Committee (SSHC-N) has instructed the Federal Office of Public Health (FOPH) to convene a round table so that the stakeholders concerned – doctors and other healthcare professionals, insurers, inpatient and outpatient services, patient organisations and cantons – can work together to find a majority solution.
- Faster and cheaper access to medicinal products
The Federal Council plans to provide rapid and cost-effective access to innovative medicinal products. To this end, the practice of pricing models with pharmaceutical companies is to be established at a legislative level. When implementing pricing models, pharmaceutical companies reimburse a portion of the price or costs incurred to insurers. This will both ensure rapid access to medicinal products and reduce the increase in the cost of medicinal products. According to the Federal Council, rapid and inexpensive access to vital medicinal products is only possible in certain cases if confidential pricing models are implemented.
- Strengthening prevention
Basic insurance should now cover the costs of preventive examinations and measures that are carried out or prescribed by a doctor. Pharmacists too should now carry out preventive measures, the costs of which are covered under basic insurance, which are implemented as part of defined programmes.
Hospitals in Switzerland
(2020, source: Federal Statistical Office)
Revision of distribution share: implementation open
In 2021, the FDHA proposed a new compensation model for the distribution of prescription medicinal products on the basis of the consultation held in 2018, which was met with criticism from the service providers concerned (pharmacies, doctors, outpatient clinics).
In 2022, the FDHA invited the associations representing the parties to collective bargaining arrangements to several meetings. Together they worked out a viable solution. Four out of five associations support this and the FDHA has taken the next steps towards approval. The date of entry into force is open.
The date of entry into force of the SBR V tariff model has still to be confirmed and depends on the introduction of the revised distribution share.
OTC mail-order business
In 2021, the Federal Council published the report entitled “Mail-order business with non-prescription medicinal products” in compliance with Postulate 19.3382 Stahl of 22 March 2019. In mid-2023, the Federal Council announced a bill submitted for consultation aimed at simplifying mail-order business with non-prescription medicinal products (OTC).
Doctors in Switzerland
(2022, source: Swiss Medical Association)
Digital transformation in the healthcare sector
Parliament has adopted a large number of parliamentary proposals relating to the digital transformation of the healthcare system. The focus is on creating rules for a health data ecosystem, the secondary use of data and a revision of the electronic patient record EPR.
In April 2022, the Federal Council announced that it would implement a two-stage revision of the Electronic Patient Record Act (EPRA). According to the Federal Council, the actual partial revision of the EPRA, which is being implemented with a view to creating the conditions for functioning and beneficial EPRs, is not expected to enter into force until 2027 at the earliest.
Central elements of the partial revision of the EPRA are:
- Compulsory for all healthcare professionals responsible for outpatients.
- Opt-out or voluntary basis for patients.
- Central storage for dynamic data, medication overview, vaccination record.
- Use of technical infrastructure for additional B2B services.
- EPR access for researchers.
Functioning electronic patient records are a prerequisite for interprofessional collaboration in integrated networks.
Current status of the EPR
Healthcare professionals must upload treatment-relevant documents to the electronic patient record (EPR) if they are members of a reference community. For some time now, hospitals, nursing homes and maternity homes have been obliged to join a reference community and manage EPRs. However, the percentage of affiliated organisations is less than 40%. This obligation also applies to registered doctors in private practice.
The number of affiliated citizens is around 10,000. The vast majority have joined the CARA reference community in the five cantons of French-speaking Switzerland.
Switzerland’s healthcare system remains in good shape. In most disciplines, waiting times are short and the quality of treatment is high. The large number of negative reports is a relatively new development. Most reporting focuses on overcrowded children’s hospitals, bottlenecks in the supply of medicinal products, a shortage of nursing staff, a lack of family doctors coming through the system, the impact of premium increases and delays in terms of digital transformation.
Parliament has been active in all the areas mentioned:
- With regard to better funding for paediatric and adolescent medicine, parliament passed two motions and, some time ago, instructed the Federal Council to take measures.
- The Federal Council has set up an expert group to propose measures against bottlenecks in the supply of medicinal products. Several associations also announced the launch of a federal popular initiative designed to alleviate the bottlenecks.
- The Federal Parliament has decided to launch a training offensive for nursing professionals following the creation of a constitutional article for nursing professions in 2021. The Federation will provide around CHF 500 million for this if the cantons provide the same amount.
- The admission requirements for specialists in selected disciplines such as family medicine and paediatric and adolescent medicine are to be lowered in order to make it easier to recruit people from abroad.
- The Federal Council has announced two partial revisions of the EPR. However, they are not expected to take effect until 2027 at the earliest.
Developments in the healthcare sector and the current backlog of reforms are a major concern for many stakeholders. The question is whether the COVID-19 pandemic is the cause of the problems or has only accelerated them. It is widely felt that major reforms are needed to solve or alleviate the diverse problems in the healthcare sector.
It is worth pointing out that provision still works well compared to the standards adopted in the rest of the world. There are, however, several countries with similar life expectancy that spend less on health per capita.
The unsatisfactory situation could help accelerate the emergence of models where doctors are no longer responsible for the triage or treatment of “minor illnesses”. Pharmacists and APN (advanced practice nursing) staff in particular could play a more important role.
As a result of this situation, the FDHA and parliament are stepping up the focus on efforts to reduce healthcare costs. It is often forgotten that reducing costs is not a primary objective. The central task of policymakers is to ensure efficient provision by means of appropriate rules. There is also a need to clarify the social policy issue of how the rising costs can be shared among citizens. The per-capita premium levels of health insurance companies are a problem for many households that do not benefit from cantonal premium reductions.
The Galenica Group remains committed to finding solutions that enable efficient service provision. It supports cost reductions if they are economically feasible and continues to oppose any measures that would effectively result in the rationing of services and thus poorer patient care.
From the point of view of the Galenica Group, interprofessional networks should be strengthened if they aim to ensure interprofessional cooperation between all stakeholders on an equal footing.