OECD Reviews of Health Systems: Switzerland 2011 OECD World Health m/& Orqanization ^- u g a
Table of Contents Introduction 9 Assessment and Recommendations 11 Chapter 1. Key Features of the Swiss Health System 23 1.1. Key features of Switzerland 25 1.2. The economic size of the health sector 32 1.3. Governance of the Swiss health system 33 1.4. Financing health care in Switzerland 34 1.5. Delivering health services 40 1.6. Provider payments, reimbursement and contracting 49 1.7. The system's efficiency: international benchmarking and future challenges 53 Notes 56 References 57 Chapter 2. Health Insurance 59 2.1. General trends in the Swiss health insurance market 60 2.2. The 1996 Health Insurance Law has strengthened solidarity, but health financing inequalities remain 64 2.3. Competition in health insurance markets does not deliver all its promises.. 71 2.4. The reform agenda 79 Notes 83 References 83 Chapter 3. Health Workforce 87 3.1. Health workforce distribution and evolution 88 3.2. Trends shaping the health workforce 93 3.3. Education 97 3.4. International health worker migration and Switzerland 102 3.5. Not only a question of numbers 105 3.6. 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... 115 4.1. Public health and prevention 116 4.2. Quality of care 121
4.3. Hospital financing 123 4.4. Pharmaceuticals 128 Notes 134 References 135 Chapter 5. Reforms and Governance of the Swiss Health System 137 Introduction 138 5.1. Main issues in health system governance identified in 2006 139 5.2. Governance traditions and principles 140 5.3. Dynamic governance or the political capacity for reform 141 5.4. Key features and instruments of governance of the Swiss health system... 142 5.5. Looking at health system objectives through the governance lens 148 5.6. Conclusion 150 Notes 151 References 152 Acronyms 155 Canton Abbreviations 156 Tables 1.1. Per capita national income by canton, 2005 26 1.2. Basic demographic indicators in Switzerland, 2009 28 1.3. Indicators of public health risks in OECD countries, 2009 30 1.4. Financing of health expenditure in Switzerland, 2009 35 1.5. Resources available in the Swiss health delivery system and other OECD countries, 2008 41 1.6. Public and private hospitals in Switzerland, 2009 46 1.7. Distribution of health expenditure by type in OECD countries, 2008 50 2.1. Types of insurance contracts within the mandatory health insurance (LAMal) 62 2.2. Trend in premium subsidies since 1999 67 3.1. Yearly number of nursing graduates and projected needs 100 3.2. Medical studies: number of applicants and capacity in universities, academic year 2010/11 101 3.3. Percentage of migrant practicing doctors and nurses in OECD countries (foreign-born) 102 4.1. Hospital financing amongst OECD countries with insurance-based systems, 2007 127 Figures 1.1. GDP per capita in OECD countries, 2010 26 1.2. Life expectancy at birth in OECD countries, 2008 27 1.3. The Swiss population by age group, 2010 and 2050 28 1.4. Share of the population considering their health to be good or very good in OECD countries, 2008 29 1.5. Share of selected causes of mortality, 2007 31 1.6. Health expenditure in OECD countries as a percentage of GDP, 2009, and changes in per capita health spending, in real terms, 1999-2009 32
1.7. Per capita health expenditure and per capita GDP in OECD countries, 2009 (or latest year available) 33 1.8. Spending on health by type of financing, 2009 36 1.9. Expenditure on promotion and prevention as a share of current health expenditure in OECD countries, 2008 42 1.10. Funding of health promotion and prevention activities in Switzerland, by financing agent, 2009 42 1.11. Main health promotion and prevention programmes of the Swiss Federal Office of Public Health by level of funding, 2011 43 1.12. Acute care beds in Switzerland and in selected OECD countries, 1998-2008 45 1.13. Share of expenditure for out-patient pharmaceuticals paid by the government or social insurers in the OECD, 2009 48 1.14. Potential gains in life expectancy through improved efficiency 54 2.1. Trends in the take-up of different types of health insurance plans among the insured population between 1996 and 2009 62 2.2. Distribution of health insurance premiums paid for adults over 25, by canton of affiliation, 2011 65 2.3. Sum of cantons' payments to providers, insurance premiums and cost-sharing on a per capita basis by canton, 2007 65 2.4. Share of population receiving premium subsidies and average level of premium subsidy per beneficiary by canton, 2009 67 2.5. 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 2007 68 2.6. Households' direct payments for health care in OECD countries, 2009 70 2.7. Health care expenditures in 2007 by income quintile (before and after adjustment for premium studies) 71 2.8. Comparison of trend in net risk equalisation volume and SHI expenditure over 1996-2009 74 3.1. Nurse/doctor ratio in Switzerland and OECD average 88 3.2. Number of physicians per 1 000 population per canton, 2009 89 3.3. Number of physicians in independent practice per 1 000 population and per canton, 1980,1990, 2000 and 2009 89 3.4. General practitioner density in OECD countries 92 3.5. Practicing physician age distribution, 1980-2010 93 3.6. Nurse age distribution, 2010 94 3.7. Physician age distribution per gender, 2010 95 3.8. Medical specialty and gender distribution 95 3.9. Number of medical and nursing graduates in Switzerland, 1980-2009 99 3.10. Number of medical graduates per 100 000 population, 1995-2008, OECD average and Switzerland 100 3.11. Requests for assistance for reintegration into the profession (nurse) per year 108 4.1. Prevalence of overweight and obesity amongst Swiss children aged 6 years to 12/13 years 117 4.2. Average length of stay for acute care across OECD countries, 2009 124
4.3. Day cases as a proportion of total surgical procedures delivered in hospitals, 2008 125 4.4. Relative retail pharmaceutical price levels in OECD countries, 2005 129 4.5. Trends in generic market share since 2002 (share of total market sales, at ex-factory prices) 132