Hospitals on the verge of a breakdown

Casualty units are regularly over-stretched Keystone Archive

Switzerland’s hospitals may be the envy of the world, but rising health costs and patient numbers are increasingly putting the system under strain.

The situation is exacerbated by an ageing population, severe budget cuts in health care and a shortage of doctors.

Hospitals are reporting that they are full and that waiting times for operations have lengthened. Casualty departments say they are admitting more and more patients.

The situation is even more evident in summer, when families go on holiday, leaving older relatives behind.

“There are lots of patients who shouldn’t be in… hospital,” Sacha Pfaender, a junior doctor in internal medicine, who has worked at the Geneva University Hospital and two other hospitals, told swissinfo.

Hospital staff say people are increasingly turning to the casualty department instead of waiting for an appointment with the family doctor.

Bern University Hospital has recorded a three per cent jump in admissions over the past two years, and Geneva saw figures rise by four per cent in 2002.

According to the Federal Statistics Office, 1.39 million patients were treated in Switzerland’s 364 hospitals at a cost of SFr14.6 billion ($10.6 billion) in 2001.

Demand for healthcare

Doctors say that since obligatory health insurance was introduced in 1996, the Swiss seem to feel they have a right to health care. This tendency has increased as health insurance has become more expensive.

Pfaender says he has also noticed a change in people’s attitudes: as people have become better informed about health, they are demanding more expensive examinations, such as a scan.

A shortage of personnel is compounding the problem, putting pressure on both staff and patients.

“There are always a few patients waiting in the bathrooms or in the corridors,” Marco Bettoni, a cardiologist and former junior doctor at Geneva University Hospital, told swissinfo.

Staff cutbacks

Bettoni and others are also concerned about continuous staff cutbacks.

Hospital staff also regularly work long hours – between 70 and 80 hours a week. One young junior doctor at Lausanne University Hospital told swissinfo he sometimes worked a 36-hour shift.

Parliament is aware of the problems and in 2002 decided to limit working hours for junior doctors to 50 hours a week – a measure due to come into force in 2005.

Under pressure from junior doctors’ unions, most cantons have now implemented the agreement, but evidence suggests that it is not always respected by some hospitals, mainly for financial reasons.

According to Christophe Gapany, junior doctor at the children’s hospital in Lausanne, patients will continue to suffer unless the workload is reduced to fit into the 50-hour limit.

More medical students

Oliver Adam, from the Bern branch of Switzerland’s junior doctors’ association, says another problem is the drop in the number of people choosing to study medicine.

In 1998 there were almost 8,000 medical students, but this figure fell to just over 7,000 last year.

One solution to make up the shortfall has been to hire foreign doctors. Around 30 per cent of hospital doctors come from abroad, mainly from Germany.

But other European countries such as Germany, France and Britain are also suffering from a shortage of medics.

swissinfo

Key facts

There are over 25,000 doctors registered in Switzerland, which has one of the highest number of doctors per head of the population in Europe.
Around 14,000 are general practitioners or specialists, and 11,000 are hospital doctors.
1.39 million patients were treated in Switzerland’s 364 hospitals at a cost of SFr14.6 billion ($10.6 billion) in 2001.
Health costs in Switzerland accounted for 10.7 per cent – or SFr43.4 billion ($31.8 billion) – of the country’s Gross Domestic Product (GDP).