Bird flu shows up holes in health system

Lack of coordination in the health system could have far-reaching consequences swissinfo C Helmle

Healthcare is the responsibility of Switzerland's 26 cantons and is not coordinated. Experts warn this could cause problems if there were a disease pandemic.

Fears have become even more acute following the advent of the deadly strain of bird flu H5N1 in Switzerland.

Of the 26 cases of bird flu reported, three have been confirmed as carrying the deadly H5N1 virus strain. Domestic poultry has not yet been affected.

Worldwide, the virus has already killed about 100 people, mostly in Asia. In the majority of cases people caught the disease through contact with infected poultry.

There have as yet been no confirmed cases of human-to-human infection, a step which experts say could fuel a mass outbreak.

Daniel Koch, a member of the Federal Health Office’s bird flu task force, told swissinfo that there were both advantages and disadvantages to the current health system in Switzerland.

“On the one hand, handing over jurisdiction to the cantons allows for action that is closer to people’s needs,” Koch told swissinfo. “On the other, it inevitably creates coordination problems.”

Exceptional circumstances

According to the 1970 law on epidemics, the government is allowed to coordinate the cantons’ activities and impose certain measures in exceptional circumstances.

However, the vagueness of the wording has led to doubts over how prepared the country would be for a health emergency.

The task force, which has come up with a new national anti-pandemic plan, is calling for a better definition of the government’s role during such crises.

The government is already preparing to revise the law, which is due to come into force in 2008.

This would allow for surveillance, information and coordination to be carried out by the government – but the application of measures would still be left to the cantons.

“In Switzerland there are 26 health systems and therefore also 26 ways of carrying out our directives,” said Koch.

“On our side, we won’t even be able to take on this task, since we lack both the means and the experience.”

Prevention

Another area where experts are calling for more coordination is disease prevention.

“The cantons’ autonomy has allowed the development of many interesting [prevention] initiatives,” Reto Obrist, director of Oncosuisse, an umbrella organisation of Swiss cancer associations, told swissinfo.

“The problem is that generally there is no coordination among the cantons.”

The lack of coordination is especially acute in measures to prevent cancer and heart disease – which between them cause two thirds of deaths in Switzerland.

“There are only tumour registers in nine cantons. While doing a good job, they are managed in different ways and certainly do not provide a complete picture of the situation,” said Obrist.

Studies

The Oncosuisse director says there are also not enough national epidemiological studies to help understand why certain types of cancer are on the rise in some areas of the country.

“Currently, tons of medical data are being gathered across the country, for example from hospitals or through the Tarmed tariff system. But, usually this information is not analysed since there is no centralised expert body.”

For this reason, cancer organisations are calling for a law that would give the government more powers in prevention matters.

But if at first it was the cantons that were reluctant to give up their privileges, it is now the federal authorities which are stalling.

“The law won’t come before 2012, perhaps only in 2020. It’s exasperating to have to wait such a long time, when it’s the population’s health at stake. But that’s Switzerland,” said Obrist.

swissinfo

Key facts

The Swiss health system costs SFr48 billion ($37 billion) a year.
Per capita, it is the second most expensive health system in the world, after the United States.
The government and the cantons give around SFr1 billion a year for health prevention and promotion.
The most common causes of death in Switzerland are: heart disease (34%), cancer (25%), strokes (8%) and lung disease (7%).

In brief

In Switzerland management of the healthcare system is the responsibility of the 26 cantons. But the government can intervene in exceptional circumstances, such as when a contagious disease prompts a health emergency.

It can also legislate over food, pharmaceuticals, drugs and dangerous chemicals.

To respond to the danger of a bird flu pandemic, the government is preparing to revise the 1970 law on epidemics.