The healthcare system of a country determines its capability in caring for its population and reducing the risks of mortality. Application or use of extensive security measures to protect the country from external attacks or wars cannot offer citizens maximum protection to people unless the government addresses other factors such as the healthcare system, economic, and use of natural resources, and political issues. Having an efficient healthcare system can significantly contribute to the development of the country by promoting the productivity of the population, improving people physical and mental health, and ensuring that funds that would have been used for managing avoidable diseases are used for other developmental purposes. The Swiss government understands the importance of healthcare and strive to offer their citizens one of the best healthcare systems globally.
This landlocked country is located in Europe and covers an area of 41,285 square kilometers. Its neighboring countries are Germany, Austria, France, Liechtenstein, and Italy. Despite its small size, the country is densely populated. As of the end of January 2020, Switzerland’s population was 8,637,259 (World Population Review, 2020). It is divided into three regions topographically, which includes the Jura Mountains located on the Northwest of the country, the Alps located in the South, which also covers approximately three-fifth of the country, and the plateau, located in the central region. The plateau are consists of fertile lands. It among the wealthiest countries globally and its GPD per head is also among the highest in its continent. It has a relatively high number of foreign nationals and a thriving economic sector. It is ranked among the top twenty exporters of high-technology products globally (Pietro, et al., 2015). Its economic status contributes to the effectiveness of its healthcare system.
The Swiss government practices a semi-direct form of democracy. The structure of their government is divided into three levels, federal, cantonal, and communal. The cantonal divisions is based on the 26 constitutions while the communal level addresses issues in the different communities. The head of the state is the federal president and their last federal election was held in 2019. Each of the 26 cantons and the half-cantons in the country has a parliament. The canton representatives are elected through a universal suffrage method. The national legislature is divided into the federal assembly, which consists of 200 members who represent the lower house (National Council) and 46 members who represent the upper house (Council of States). Each canton elects two representatives who form part of the upper house, while each half-canton elect one representative. Decision-making is made through referendums as any law passed by both houses, which affects the constitution, is subjected to a referendum if 50,000 citizens or eight cantons disagree with the law. Citizens are also allowed to initiate changes in the constitution by collecting 100,000 signatures for a petition (Levy, Lord, & Nevins, 2015). These measures have ensures that the country is run in a democratic manner.
When considering the power distribution of the Swiss government, the national government oversees major decision-making that might involve alteration of the constitution, national security, and the country’s economy while the cantons run hospitals within their regions, educational facilities, and oversee their police forces. The healthcare duties in the country are divided among the federal, cantonal, and municipal governments. Some of the healthcare roles played by the federal government include regulating the financial system through development of health insurance policies, ensuring the safety of pharmaceutical products and medical devices, and financing research and training (Sturny, 2019). This division promotes collaboration and accountability.
The municipalities work collaboratively with the cantons in managing hospitals, long-term care facilities like nursing homes, and supporting other social services put in place to assist vulnerable populations (Sturny, 2019). This system ensures that appropriate authorities oversee all aspects of the country’s healthcare system. Decision regarding the health system are also shared with recognized civil society corporations such as health insurance companies and associations for healthcare providers. Additionally the Swiss people can also demand for reforms by holding public referendums (Pietro, et al., 2015). This ensures that concerns raised by the public can also be addressed.
Components of the Healthcare System
The health system in this country is highly complex and focuses on addressing different aspects of its population health needs. General practitioners (GPs) run most of the primary care facilities who offer their services to a wide range of people as registering with a specific GP is not allowed in the country. Nurses and other healthcare professionals play a minimum role at this level, as these facilities do not usually manage chronically ill patients. Another division of the healthcare system include the outpatient specialist care that are run by different specialists and offer residents free access to specialists without the need for referrals (Sturny, 2019; Pietro, et al., 2015). Specialists are allowed to cater to both private patients and those who have a health insurance plan.
Cantons are responsible for overseeing facilities that offer after-hours care, which includes a network of ambulances, emergency services, late-night walk-in clinics, rescue, and telehealth services. Other divisions includes hospitals, mental health facilities, social support and long-term care. In 2014, the country had 289 hospitals. Nurses and other healthcare providers work collaboratively in hospitals to ensure that patients receive quality care. Most of the mental health facilities are run by private companies or individuals, while other are part of hospitals. Long-term facilities such as palliative centers, nursing homes, or at home facilities offer their services to in-patient clients (Sturny, 2019). Patients are required to go through proper assessment in hospitals to determine their need of these services before being admitted to long-term facilities. Social service also forms part of the healthcare system in the country and focuses on vulnerable individuals (Pietro, et al., 2015). The image in appendix 1 provides a visual representation of the Switzerland healthcare system.
The healthcare system in the country is financed through the different levels of the government with the highest ratio of the healthcare funding (32.4%) being financed through taxation. Approximately 30% of the healthcare costs are catered for by the health insurance system. Social insurance schemes contribute largely in financing healthcare costs in the country. The next largest component in healthcare financing is the out-of-pocket option, which amounts to 26.0% of the total health expenditure (THE). Cantons also cover some of the healthcare costs through government expenditures, which accounts to 20.3% of THE. In the country, private financing is the main source of healthcare costs especially in services offered in long-term facilities and private consultation firms. Majority of the residents in the country have health insurance. All the residents obtain their insurance through the Mandatory Health Insurance (MHI) system (Pietro, et al., 2015). Immigrants or newborns are required to obtain health insurance within three months.
Healthcare System Staffing and Management
Research has shown that most of the healthcare practitioners working in hospitals and other healthcare facilities in Switzerland are highly satisfied with their working environments, their access to pharmacological products, and the management approaches used in their facilities. The effectiveness of their health systems and job satisfaction rates has also attracted more foreign nurses and other healthcare practitioners from different countries. The inflow of foreign healthcare practitioners assists the country in maintaining a stable healthcare workforce and reduces cognitive exhaustion among healthcare practitioners. In turn, this promotes the overall quality of care in the country. Healthcare leaders who are in-charge of hospitals and other facilities collaborate with education institutions in developing trainings for their staff. This contributes to healthcare practitioners’ satisfaction with the systems as they are offered numerous opportunities to advance their skills. Research shows that nurses working in Switzerland have high expectations of their leaders regarding access to life-long learning opportunities, involvement in policy development, and decision-making (Biegger, Geest, Schubert, & Ausserhofer, 2016). Involving the staff in policy development and decision-making promotes mentorship, better leadership, and provision of quality services.
Healthcare Problems of the Population
The average life expectancy of Swiss citizens is 82.8 years while that for disabled individuals is 70.5 and 73.8 in women and men respectively. The leading causes of deaths in the country are diseases affecting the circulatory system and cancers. The third commonest cause of death in the country is accidents and other external factors like falls and injuries. Non-communicable diseases accounted for 85% of the burden of disease in the country in 2013 and was responsible for approximately 80% of the overall healthcare costs (Pietro, et al., 2015). Recently, the outbreak of the Coronavirus has been a healthcare issue in the country, as the number of patients diagnosed with the virus has passed the ten thousand mark. As of March 25, the number of reported cases were 10,388 and those who had died were 143 (Ehrenzeller, 2020). Despite the challenges posed by the virus, the country’s healthcare system continues to strive to offer their patients with quality services.
Strengths, Weaknesses, and Rank
Some of the strengths of the healthcare system in Switzerland include guaranteed access to high-quality healthcare services, ability to select consultants or specialists based on patients’ choices as opposed to use of strict referral procedures, and proper staffing of healthcare facilities. From a health insurance company perspective, the existence of co-payment options helps patients to cater for their health services and reduces risks of overuse. The MHI also ensures that all residents regardless of their economic status have access to health insurance (Pietro, et al., 2015). These factors explain why the Swiss healthcare system is ranked among the best globally. According to an assessment performed by the Commonwealth Fund in 2017, which looked at 72 indicators that were selected from five domains, the Swiss health care system was ranked the second best globally after the United Kingdom. The five domains included access to care, equity, care processes, patient outcomes, and administrative effectiveness (Schneider, Sarnak, Squires, Shah, & Doty, 2017). The performance of different countries was calculated in each domain.
One of the weaknesses of the Switzerland healthcare is based on the health insurance premiums that are rise constantly making it challenging for some of the citizens to access basic healthcare services. This suggests that there is a correlation between the country’s insurance market and the weakening of access to healthcare services (Unger & Paepe, 2019). Since the national government participates in controlling the healthcare systems in each of the cantonal divisions, there are additional costs and administrative complexities that the cantons and the municipal governments encounter, which could otherwise be directed towards drugs and treatments.
Similarities to US System
There are numerous similarities and differences between the Switzerland and the US healthcare system. Both countries emphasize on the need for obtaining health insurance. After the implementation of the Affordable Care Act in 2010, more Americans sought to obtain a health insurance plan. Both countries also promote access to healthcare services through their health insurance policies and other health promotion programs. In the US, the Medicaid and Medicare insurance plans have increased access to healthcare services by approximately 95 percent. The country has seen a 25% decrease in the number of Americans who cannot access health services (McIntyre & Song, 2019). In Switzerland, residents are required to obtain the MHI within the first three months of residence in the country (Pietro, et al., 2015). This promotes their access to affordable health services.
The ratio of nurses to patients in Switzerland is lower than that seen in the United States. In a research that assessed the effectiveness of care in European counties and in the United States, Switzerland was seen to have a lower nurse to patient ratio. In the US, the research showed that nurses who cared for more patients and those who worked for more hours had a higher likelihood of missing some aspects of the care giving practice. In Europe, nursing shifts that had less than six patients were linked with a 53% reduction of missed care (Griffiths, et al., 2018). In Switzerland the citizens buy health insurance for themselves, which promotes transparency. This is different from the US where there are medical benefits offered by employers. In Switzerland, patients do not require a referral to seek the services of consultants, which is different from the US system where referrals are essential in ensuring that the services are incorporated in the health insurance plan (Pietro, et al., 2015). This ensures that patients in Switzerland have a faster access to needed care.
Some of the unique aspects of the Switzerland healthcare system include consistent promotion of health education and awareness, mandatory insurance coverage for all residents, proper administrative management in both local governments and healthcare facilities. Additional the no referral policy that indicates that patients do not necessarily need a referral to obtain services from specialists is also a unique feature. The poor receive a subsidized healthcare plan to ensure that they do not spend most of their household income of health insurance (Pietro, et al., 2015). Their uniqueness of their health insurance plans and proper staffing in healthcare facilities promotes better access to quality services.
Conclusion and Recommendations
Based on the review, most of the mental health facilities in the country are privately owned, which reduces access to these services to regular citizens who have not been referred to these facilities. One of the areas that the healthcare system can improve is the integration of the mental health facilities and psychiatric care into primary care systematically. Integrating these systems could promote access to mental health services at community level. This would ensure that these services are not only limited to patients who have private health insurance. Another recommendation that could improve the quality of care in the Swiss healthcare system is the standardization of health insurance premiums. This could promote citizens commitment to seeking regular healthcare services. Generally, the Swiss government has worked hard in ensuring that they offer the best healthcare services to their population. Their success can be attributed to the collaboration of the different government divisions and the health sector.
Biegger, A., Geest, S. D., Schubert, M., & Ausserhofer, D. (2016). The ‘magnetic forces’ of Swiss acute care hospitals: A secondary data analysis on nurses׳ job satisfaction and their intention to leave their current job. Elsevier, 2, 15-20. Retrieved from https://www.sciencedirect.com/science/article/pii/S2352900816000030.
Ehrenzeller, G. (2020, March 25). Coronavirus: the situation in Switzerland. Retrieved from SwissInfo.ch: https://www.swissinfo.ch/eng/covid-19_coronavirus–the-situation-in-switzerland/45592192
Griffiths, P., Recio-Saucedo, A., Dalla’Ora, C., Briggs, J., Maruotti, A., Meredith, P., . . . Ball, J. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-1487. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jan.13564.
Levy, P., Lord, R., & Nevins, D. (2015). Switzerland (3rd ed.). Cavendish Square Publishing, LLC,.
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS Medicine, 16(2): e1002752. Retrieved from https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002752.
Pietro, C. D., Camenzind, P., Sturny, I., Crivelli, L., Edwards-Garavoglia, S., Spranger, A., . . . Quentin, W. (2015). Switzerland Health System Review. Europe Observatory on Health Systems and Politics, 17(4), 1-323. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0010/293689/Switzerland-HiT.pdf?ua=1.
Schneider, E. C., Sarnak, D. O., Squires, D., Shah, A., & Doty, M. M. (2017, July 14). Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. Retrieved from The Commonwealth Fund: https://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-2017-international-comparison-reflects-flaws-and
Sturny, I. (2019). The Swiss Health Care System. Retrieved from The Commonwelth Fund: International Health Care System Profiles: https://international.commonwealthfund.org/countries/switzerland/
Unger, J.-P., & Paepe, P. D. (2019). Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency? International Journal of Health Services, 49(3), 431–456. Retrieved from https://doi.org/10.1177/0020731419847113.
World Population Review. (2020). World Population Review. Retrieved from Switzerland Population 2020: https://worldpopulationreview.com/countries/switzerland-population/