Healthcare costs in Switzerland are among the most expensive in the world: in fact, they’re second only to the US. Yet, Swiss citizens can’t boast of an elevated life expectancy, nor do they benefit from a longer healthy life expectancy, which is a major concern among developed nations facing the challenges of ageing populations. It’s clear that change is needed. We spoke to Stéfanie Monod, titular professor at the University of Lausanne, Senior Physician and Co-Head of the Department of Epidemiology and Healthcare Systems at Unisanté and former Director of Vaud’s Health Directorate, about the current system’s complexities and opportunities for reform.

The organisation of the Swiss healthcare system is, in Stéfanie’s words, ‘a bit of a mismatch’. This is because the system relies on mandatory, nationwide social insurance, called l’assurance maladie (LAMal), which is regulated by the Swiss Confederation; however, it’s the local cantons that actually have responsibility for ‘health’, broadly speaking, and that organise healthcare provision. Stéfanie explained: ‘When you think only of the healthcare system – that means doctors, services and so on – the canton is responsible for organising this offer for citizens. But the canton has absolutely no power over the way it’s financed: this is in the hands of ‘tariff partners’ and controlled at the federal level. The organisation of the system, which separates service provision and funding governance, leads to big roadblocks.’

Naturally, this has a negative impact on patients – who are already paying through the nose for healthcare services. Indeed, Stéfanie expressed frustration that the Swiss healthcare system falls so short, when ‘we certainly don’t lack money, but we don’t put it in the right places’. In this, she pointed to the limited availability of primary care and high levels of bureaucracy in the Swiss system, which are then compounded by high premiums and deductibles, leading to a worryingly high renouncement rate: in the past 12 months, one in five people in Switzerland didn’t seek medical treatment, even in an emergency.

To be sure, as Stéfanie was keen to stress, there is no perfect healthcare system existing in the world today: to take just two examples, the pitfalls of the UK healthcare system (with its long waiting lists) or the French system (with its déserts médicaux) are well known. Nonetheless, Swiss citizens are grappling with serious access barriers: proportionally, they pay more for healthcare, in terms of overall household expenses, than any other developed country (in the OECD). What’s more, they don’t reap any major benefits from this expenditure: according to Stéfanie, who cited statistics from Our World in Data, ‘if you look at life expectancies across Europe, particularly healthy life expectancies, Spain is ahead of us and we’re about the same as Italy (despite putting almost twice as much money into our system as Italy). As things stand, we’re obviously underperforming.’

A gathering storm on the horizon: The challenges of an ageing population, which no amount of innovation will solve

Exacerbating this, Switzerland, like many other western nations, is facing a ticking timebomb in the shape of its ageing population.

It can’t be denied that physicians, researchers and entrepreneurs have made huge breakthroughs over the past century, completely transforming the field of medicine and our understanding of disease. ‘It’s not out of the question,’ Stéfanie asserted optimistically, ‘that we will be able to treat and/or cure numerous diseases at some point in the future.’ Notably, this is where most of the private investment in the Swiss healthcare system is currently directed – entrepreneurs and researchers are constantly developing innovative ways to understand illness and produce new treatments that may change the face of modern medicine.

Still, in Stéfanie’s eyes, this represents another misdirection of time, energy and money: she stated that ‘the impact of these innovations, which may well be gamechangers in 20 to 30 years, do not answer short-term needs, as physicians will actually need to focus on tackling age-related diseases like Alzheimer’s’. As she asserted: ‘Most of the people who are now 50, 60 or 70 years old will probably still be alive in 20 years’ time – and their healthcare status is pretty much already decided: they will need a lot of care, which will, in turn, cost a lot’.

That’s not to say, of course, that innovative research and development should stop; Stéfanie just wanted to temper any expectations that breakthroughs being made now will solve the oncoming crisis, and she suggested we reconsider where we’re focusing all our attention. In her words, ‘I don’t believe the people of my generation and the generation above – the baby boomers – will benefit much from new biotech and medtech discoveries, and yet they’re the ones who are going to need all the help they can get over the next few years. Maybe we need to rethink what we’re doing at the moment.’

The importance of prevention moving forward

On the other side of the coin, for babies and young children, the future is still to be decided. As such, Stéfanie argued that ‘the most sensible course of action would actually be to invest in preventative care and education for children: if we can teach people from a young age about the importance of good nutrition, physical exercise, social stimulation and the environment, we’ll be in a much better position.’

After all, as Stéfanie reminded us, health outcomes aren’t produced solely by the healthcare system – far from it. In fact, only around 10% of the elements that make us ‘healthy’ are tied to healthcare, as asserted by The Health Foundation; the other 90% come from genetics, environmental factors like pollution, and individual behaviour linked to diet and exercise, among others. But, as things stand, Stéfanie estimated that around 90% of the available funds are channelled into this 10%; in other words, a lot of money is put into treating ailments, rather than improving the bigger picture, which makes for a battle between David and Goliath. Stéfanie asserted: ‘In the next 20 years, I’d like see a lot more emphasis on our environment; if we actually want to prevent ill health in the future (and also encourage good societal cohesion), this is where we need to focus.’

Hopes for the future: An ideal Swiss healthcare system?

As stated above, the world is yet to come up with a perfect blueprint for healthcare systems. Still, we discussed what questions governments and regulators need to be asking themselves moving forward, in order to best serve citizens.

For Stéfanie, it came down to one central issue: what’s the minimum level of care that everyone should have access to? In her eyes, this should be an intrinsic part of the social fabric. She posited that ‘Switzerland, a rich country, surely should be able to offer all its citizens a high level of healthcare. Of course, we don’t have to move to a fully centralised and public system (following the example of the UK), but we ought to be able to find a middle path that suits us.’

In this, she alluded to what she fears the Swiss system will become without significant reform: ‘By all means, the Swiss healthcare system is a good market, as set out in a recent report from the World Health Organization – there is plentiful investment and this money circulates well. But at present, patients derive few advantages from the high levels of expenditure within this system. So, if we don’t tackle its issues, it will end up only being a market, not a system.’

Notably, the Swiss healthcare system hasn’t seen any major reforms since the 1990s – so, there’s no time like the present to act. In her capacity as a physician, professor and former health authority, Stéfanie is actively seeking to ‘build legal health competency at the confederation level’ and encourage healthcare to be treated as ‘a pressing political issue’. She left with us much food for thought, as she questioned: ‘What actually are the objectives of a well-functioning healthcare system? What can we do to reorganise our existing system with an improved financing structure and distribution of human resources? How are we going to finance long-term care for the elderly and build up our healthcare workforce?’ And she expressed hope for the future, as she reminded us of the high quality of the Swiss healthcare system and wondered: ‘Just think of what we could achieve if we were to orientate ourselves in the right direction? We really could perform at the top of our game…’