title: Switzerland: Health System Review.
abstract: This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to the financing of the health system than higher-income households. Flawed financial incentives exist at different levels of the health system, potentially distorting the allocation of resources to different providers. Furthermore, the system remains highly fragmented as regards both organization and planning as well as health care provision.
authors.affiliation: Department of Business Economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Pietro
authors.affiliation: Swiss Health Observatory (Obsan) in Neuchatel.
authors.forename: Paul
authors.initials: P
authors.lastname: Camenzind
authors.affiliation: Swiss Health Observatory (Obsan) in Neuchatel.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sturny
authors.affiliation: Department of Business Economics, Health and Social Care at the University of Applied Sciences and Arts of Southern Switzerland, Universita della Svizzera Italiana and Swiss School of Public Health.
authors.forename: Luca
authors.initials: L
authors.lastname: Crivelli
authors.affiliation: European Observatory on Health Systems and Policies and Department of Health Care Management at the Berlin University of Technology.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Edwards-Garavoglia
authors.affiliation: European Observatory on Health Systems and Policies and Department of Health Care Management at the Berlin University of Technology.
authors.forename: Anne
authors.initials: A
authors.lastname: Spranger
authors.affiliation: European Observatory on Health Systems and Policies and Department of Health Care Management at the Berlin University of Technology.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Wittenbecher
authors.affiliation: European Observatory on Health Systems and Policies and Department of Health Care Management at the Berlin University of Technology.
authors.forename: Wilm
authors.initials: W
authors.lastname: Quentin
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000379:methods* / Q000458:organization & administration*; D018166:Health Care Reform; D005102:Health Expenditures; D006291:Health Policy; D061889:Healthcare Financing; D006801:Humans; D007348:Insurance, Health; D008017:Life Expectancy; D011787:Quality of Health Care; D013557:Switzerland