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“Health patterns worldwide and in Switzerland have been changing [5,46]. Indeed, not only has the prevalence of chronic diseases such as cancer, diabetes, COPD, asthma and depression increased significantly, but many people have multiple coexisting (chronic) somatic and mental health conditions (multimorbidity) as well as social needs [3]. In spite of this epidemiological situation, data about the distribution of care provision in Switzerland is scarce [47], making it difficult to assess the numbers and specialities of the professionals involved in patient care or their degree of collaboration. However, in light of the increasing financial burden and number of annual medical consultations per capita, we may wonder whether Swiss patients face risks of information loss or discrepancies, potential concomitant over-investigation, over-treatment, complications, emergencies and rehospitalisation, with their concurrent negative effects on patient outcomes and costs [3,48,49,50].

“These elements call out for improvements to IC [Integrated Care]. However, its potential to improve efficiency, patient safety and the quality of outcomes is only being exploited minimally in Switzerland, despite the various policies previously described showing that IC is acknowledged by growing numbers of stakeholders at the national, cantonal and local levels. This can probably be explained by Switzerland’s federal system [51]. From a change management perspective [52], this federal, decentralised system enables ad hoc innovations to be triggered by local leaders of change. However, it also leaves space for inertia and resistance to change. In order to implement IC more broadly, all across the country and in its various local contexts, the Swiss healthcare system needs robust health system building blocks [9,53]. These building blocks include initial and continuous education addressing IC both for practitioners and managers [34], adjusted financing schemes promoting coordination [54], and interoperable clinical information tools [36]. While most of these building blocks have emerged already, they will only stabilise and spread with a subtle combination of centralized and decentralized impulses. In addition to these building blocks, proactive change management strategies should make IC easy and desirable, not only to early adopters, but also to the majority of the country’s healthcare stakeholders [52,55]. Among them, healthcare system users should be more explicitly included as their perspectives would reinforce the relevance and desirability of IC [56]. While direct democracy enables lobbies such as health insurers or health professionals to have representatives at the federal level, the patients’ lobby remains poorly represented and still lacks power of action in Switzerland. However, whereas the patient-as-partners approach has been adopted at the international level (e.g. Canada [57]), care institutions in Switzerland have only recently included formal patient expertise in their governance (e.g. Geneva [58]). Finally, supporting IC in Switzerland will also contribute to its health system performance, as advocated for by the successive Triple to Quintuple Aim approaches [59,60,61,62]. However, due to the lack and/or the opacity of data (e.g. quality of services, negotiation of payment rates) [17,47], assessing this performance remains a challenge.”

Source: Filliettaz SS, Berchtold P, Koch U, Peytremann-Bridevaux I. Integrated Care in Switzerland: Strengths and Weaknesses of a Federal System. Int J Integr Care. 2021;21(4):10. Published 2021 Oct 29. doi:10.5334/ijic.5668

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“In Germany and Switzerland, the preconditions ‘effective competition policy’ and ‘contestability of the markets’ are also not sufficiently fulfilled in 2022, just as in 2012. Another remarkable finding is that the precondition ‘freedom to contract and integrate’ is hardly/moderately fulfilled in Germany and Switzerland. In these countries the government or a cartel of insurers functions as the third-party purchaser of care, rather than individual insurers. However, as argued in our earlier paper [5], giving consumers a free choice of insurer only makes sense if the individual insurer is the third-party purchaser of care. Otherwise, the considerable effort in solving problems of risk selection is largely wasted because the potential efficiency gains are negligible. One may wonder whether this is a (long) interim-period towards regulated competition or whether it is going to be the long-term status quo. In the latter case one may doubt whether this is a sustainable model of healthcare organization. The rationale of regulated competition in healthcare is that individual insurers have the primary responsibility for purchasing or delivering care. There seems to be no rationale for allowing consumer choice among risk bearing insurers if insurers cannot distinguish themselves as individual purchasers of care.”

Source: van de Ven WP, Beck K, Buchner F, et al. Preconditions for efficiency and affordability in competitive healthcare markets: are they fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland? Health Policy. 2013;109(3):226-245. doi:10.1016/j.healthpol.2013.01.002

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“There are two important fields in which legislative activity is currently ongoing: one is the area of quality improvement and HTA [Health Technology Assessment], where a draft Federal Law on the Centre for Quality in MHI [Mandatory Health Insurance] was recently abandoned in favour of the idea of a Network for Quality in Health Care. The other is the area of e-health, where a proposed Federal Law on Electronic Health Records (EPDG/LDElP) was adopted by Parliament on 15 June 2015.

“In fact, improving quality management and HTA has already been on the political agenda for quite some time. In 2009, the FOPH published a National Quality Strategy for the Health System (FOPH, 2009) and measures to implement the strategy were proposed in 2011 (FOPH, 2011b). In the area of HTA, two associations have been founded since 2008 (the Swiss Medical Board and SwissHTA), which aim to promote the use of HTA for decision-making on health care coverage (see section 2.7.1), and consensus seems to be emerging that a stronger process for systematic HTA is needed. A draft Federal Law on the Centre for Quality in MHI was proposed in 2014 with the aim of creating a national centre for quality as a public institution under the Federal Council (Federal Council, 2014). This new structure would have strengthened activities of the federal government in the areas of quality management, patient safety and HTA.

“However, during a preliminary parliamentary consultation process, it became evident that considerable opposition existed against the creation of a new institute. In particular, concerns were raised by many actors concerning the relationship between the new institute and existing structures, such as the ANQ [National Association for Quality Improvement in Hospitals and Clinics], the Foundation Patient Safety Switzerland and the Swiss Medical Board.

“Opposition was strongest at the level of the corporatist actors, such as MHI companies, hospitals, physicians and the existing institutions. Together, these actors lobbied for strengthening existing multi-stakeholder structures instead of creating a new institute under the Federal Council. As a result, the Federal Council is now proposing to set up a Network for Quality in Health Care and the FOPH [Federal Office of Public Health] is currently drafting a new proposal for an amendment to KVG/LAMal [Federal Health Insurance Law] (FOPH, 2015a). The idea is to strengthen existing institutions, programmes and projects by securing sufficient financial resources for quality management, patient safety and HTA.”

Source: De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health system review. Health Systems in Transition, 2015; 17(4):1–288.

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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.

Page last updated August 7, 2025 by Doug McVay, Editor.