Experts in “Eco Talk” are convinced that if the cantons worked together better, costs could be saved.
The Swiss pay a lot for their health: 11.3 percent of the gross domestic product went into the health sector last year. This means that Switzerland is divided according to OECD together with Great Britain in an international comparison sixth place. The USA spends the most (16.6 percent), followed by Germany (12.7 percent), France (11.9 percent), Japan (11.5 percent) and Austria (11.4 percent).
A third of the cost
They paid in 2021 compulsory health insurance medical services amounting to 36.3 billion francs. Outpatient medical costs come first at 23 percent, medication comes second at 22 percent, and inpatient and outpatient hospital stays come third at 19 and 14 percent. The hospitals account for a third of the costs and therefore a huge cost block.
Hospitals and locations
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Number of hospitals: 276
General hospitals: 104
Center care: 44Basic care: 60
Specialty clinics: 172
Psychiatrie: 49Rehabilitation/Geriatrie: 51Andere: 72
Number of locations: 579
One reason is the high hospital density with 276 hospitals. According to the director of the health insurance association Curafutura, Switzerland has too many hospitals compared to other countries and also for its own needs. Pius Zängerle: “The hospitals employ staff, they provide services that are sometimes doubled or tripled and that make no sense.” This also contributes to the shortage of skilled workers: “By providing services that are not really needed,” says Zängerle.
Each canton looks for itself
But when it comes to hospital planning, each canton now looks for itself. This leads to oversupply. In some cases, hospitals in the immediate vicinity, but with a cantonal border in between, offer the same services. Experts such as health economist Tilman Slembeck have therefore long been calling for cross-canton care networks for around 1.5 million residents. Five to six health regions in Switzerland would make sense.
There should be a large central hospital for each region – ideally a university clinic. This would be primarily responsible for the most complex treatments. In addition, regional hospitals, health centers, general practitioners, Spitex and Co. would offer basic medical care. The aim of the health regions: Save costs without sacrificing quality because the hospitals would complement each other and everyone would no longer have to offer everything.
Mergers have a hard time: In February 2019, 68 percent of Basel voters said yes to the merger of the Cantonal Hospital of Baselland and the University Hospital of Basel to form the new University Hospital Northwest. But the people of Basel clearly rejected the merger with 56 percent. And this despite the fact that opponents and supporters of the proposal actually agreed that there are too many hospitals in a small area in the Basel region and that health care costs in the Basel region are among the highest in Switzerland. Jörg Leuppi, chief physician at the Baselland Cantonal Hospital: “That would have been a unique opportunity to set up sensible hospital planning in the region.”
It could also be different. Pius Zängerle: “Today the Stans Hospital, where I was once president, is fully integrated with the Lucerne Cantonal Hospital.” The same thing, he is convinced, would also be possible in Obwalden and, to a certain extent, in Uri: “That is the path that you have to take – it takes time and it is a rocky path – but it is the right path.”