How to Improve Care for Patients with Complex Needs in the

Framework of the Swiss Health Care System?

Thomas ZeltnerProfessor of Public Health, University of Bern, Switzerland.Former Secretary of Health of Switzerland (1991-2009)

Commonwealth Fund International Survey Webinar January 11, 2012

GovernmentRegulator

Citizen,Customer

Patient

Health ServiceProvider

HealthInsuranceCompany

The Regulated Market Model of Switzerland

< 1/3 mile

< 3 miles

Specific Aspects of the Swiss Health Care Systems

GPs and Specialists are allowed to(and are reimbursed by the social health insurance)

- Run their own laboratories- Dispense medications (in part of the country)- Offer methods of “complementary medicine”- Offer X-ray examinations

Specific Aspects of the Swiss Health Care Systems

Number of Hospitals in Switzerland (7.8 Mio Citizens):

General Hospitals 119Specialized Clinics 178TOTAL 297

Specific Aspects of the Swiss Health Care Systems

Challenges for the Future

Challenges for the Future:Density of General Practitioners

Health Insurance Plans in Switzerland (2010)

Gate Keeper Models (without Capitation)

Managed Care Models with Capitation

Models with Telemedicine

“Regular Insurance Plans”

Challenges for the Future:

Challenges for the Future:

35%

35%

20%

10%

Determinants of Health

Health BehaviorsSocioeconomic FactorsClinical CareGenetics

Challenges for the Future:

0

2

4

6

8

10

12

14

16

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia

Total expenditures on health as percent of GDP

Next Reforms of the Swiss Health Care System:

Strengthening the Position of General Practitioners (2009)

Integrated Care shall become “Regular Model of Care” (2012)

Strengthening Health Promotion/Disease Prevention (2012)

Introducing Disease Management Programs (2014)