OECD Reviews of Health Systems: Switzerland

Transcription

1 OECD Reviews of Health Systems: Switzerland 2011 OECD World Health m/& Orqanization ^- u g a

2 Table of Contents Introduction 9 Assessment and Recommendations 11 Chapter 1. Key Features of the Swiss Health System Key features of Switzerland The economic size of the health sector Governance of the Swiss health system Financing health care in Switzerland Delivering health services Provider payments, reimbursement and contracting The system's efficiency: international benchmarking and future challenges 53 Notes 56 References 57 Chapter 2. Health Insurance General trends in the Swiss health insurance market The 1996 Health Insurance Law has strengthened solidarity, but health financing inequalities remain Competition in health insurance markets does not deliver all its promises The reform agenda 79 Notes 83 References 83 Chapter 3. Health Workforce Health workforce distribution and evolution Trends shaping the health workforce Education International health worker migration and Switzerland Not only a question of numbers The challenge of developing a national and long-term vision on health workforce issues 108 Notes 110 References 110 Chapter 4. Recent Health System Reforms and Progress since the 2006 Review Public health and prevention Quality of care 121

3 4.3. Hospital financing Pharmaceuticals 128 Notes 134 References 135 Chapter 5. Reforms and Governance of the Swiss Health System 137 Introduction Main issues in health system governance identified in Governance traditions and principles Dynamic governance or the political capacity for reform Key features and instruments of governance of the Swiss health system Looking at health system objectives through the governance lens Conclusion 150 Notes 151 References 152 Acronyms 155 Canton Abbreviations 156 Tables 1.1. Per capita national income by canton, Basic demographic indicators in Switzerland, Indicators of public health risks in OECD countries, Financing of health expenditure in Switzerland, Resources available in the Swiss health delivery system and other OECD countries, Public and private hospitals in Switzerland, Distribution of health expenditure by type in OECD countries, Types of insurance contracts within the mandatory health insurance (LAMal) Trend in premium subsidies since Yearly number of nursing graduates and projected needs Medical studies: number of applicants and capacity in universities, academic year 2010/ Percentage of migrant practicing doctors and nurses in OECD countries (foreign-born) Hospital financing amongst OECD countries with insurance-based systems, Figures 1.1. GDP per capita in OECD countries, Life expectancy at birth in OECD countries, The Swiss population by age group, 2010 and Share of the population considering their health to be good or very good in OECD countries, Share of selected causes of mortality, Health expenditure in OECD countries as a percentage of GDP, 2009, and changes in per capita health spending, in real terms,

4 1.7. Per capita health expenditure and per capita GDP in OECD countries, 2009 (or latest year available) Spending on health by type of financing, Expenditure on promotion and prevention as a share of current health expenditure in OECD countries, Funding of health promotion and prevention activities in Switzerland, by financing agent, Main health promotion and prevention programmes of the Swiss Federal Office of Public Health by level of funding, Acute care beds in Switzerland and in selected OECD countries, Share of expenditure for out-patient pharmaceuticals paid by the government or social insurers in the OECD, Potential gains in life expectancy through improved efficiency Trends in the take-up of different types of health insurance plans among the insured population between 1996 and Distribution of health insurance premiums paid for adults over 25, by canton of affiliation, Sum of cantons' payments to providers, insurance premiums and cost-sharing on a per capita basis by canton, Share of population receiving premium subsidies and average level of premium subsidy per beneficiary by canton, Average LAMal premium burden after the payment of premium-reduction subsidies, as a share of disposable income, for five types of households, in 1998, 2002 and Households' direct payments for health care in OECD countries, Health care expenditures in 2007 by income quintile (before and after adjustment for premium studies) Comparison of trend in net risk equalisation volume and SHI expenditure over Nurse/doctor ratio in Switzerland and OECD average Number of physicians per population per canton, Number of physicians in independent practice per population and per canton, 1980,1990, 2000 and General practitioner density in OECD countries Practicing physician age distribution, Nurse age distribution, Physician age distribution per gender, Medical specialty and gender distribution Number of medical and nursing graduates in Switzerland, Number of medical graduates per population, , OECD average and Switzerland Requests for assistance for reintegration into the profession (nurse) per year Prevalence of overweight and obesity amongst Swiss children aged 6 years to 12/13 years Average length of stay for acute care across OECD countries,

5 4.3. Day cases as a proportion of total surgical procedures delivered in hospitals, Relative retail pharmaceutical price levels in OECD countries, Trends in generic market share since 2002 (share of total market sales, at ex-factory prices) 132